An article from University of Oslo
Ibuprofen cannot replace antibiotics to treat urinary tract infections
Antibiotic resistance is a major global problem. Nevertheless, we should not stop using antibiotics to treat urinary tract infections.
University of Oslo
One of our era’s greatest health challenges is bacteria that are resistant to antibiotics. The main reason some bacteria have developed resistance is our use of antibiotics. It is therefore important to reduce unnecessary use of antibiotics and find alternative solutions.
“Antibiotic resistance poses a threat to all forms of modern medicine,” says Ingvild Vik at Helsam.
“Cancer treatments, neonatal medicine, organ transplantation and prosthetic surgery all depend on functioning antibiotics. We must be able to prevent and treat infections,” she continues.
Major reason for antibiotic use
Half of all women will have a urinary tract infection at least once in their lifetime, and this bacterial infection is the second largest cause of antibiotic use in general practice. Urinary tract infections often clear up without treatment and have been regarded as a good place to reduce antibiotic use.
In 2010 a German pilot study showed that ibuprofen gave as quick pain relief as antibiotics in women with an uncomplicated urinary tract infection. Ingvild Vik has now conducted a major clinical trial to see whether these findings can be confirmed.
“We know that uncomplicated urinary tract infections in women, such as cystitis, are a self-limiting condition that often clears up by itself. Anyone who has had cystitis knows that it can be very painful and annoying and that antibiotics provide quick symptomatic relief. Women who are encouraged to wait it out and drink a lot of fluids often find that the infection goes away without antibiotics. We therefore wanted to investigate whether a painkiller, ibuprofen, could provide as good symptom relief as antibiotics,” she said.
Antibiotics provided better symptom relief
Vik and her colleagues compared ibuprofen with the antibiotic pivmecillinam. 383 women in Scandinavia participated in the study. 181 patients were given ibuprofen and 178 were given pivmecillinam. Neither the participants nor the doctors treating them knew who received which.
After four days, the status was: 74% of the patients who had received antibiotics felt better, while only 39% of those who had been given ibuprofen felt well.
Complications among the participants given ibuprofen
Over half of the women who took ibuprofen eventually recovered without antibiotic treatment. A little under half did not recover and had to return to the doctor for antibiotic treatment.
Of those who returned, seven patients developed kidney infection, and five had to be hospitalized. None of the participants in the antibiotics group developed kidney infection.
Previous studies have not shown a high incidence of kidney infections in the placebo groups. Vik and her colleagues therefore wonder whether there may be properties of ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), that cause some patients to develop more serious complications.
Ibuprofen alone is not recommended
Vik concludes that ibuprofen cannot be recommended as an alternative to antibiotic treatment for women with a urinary tract infection.
“Treatment with ibuprofen may reduce unnecessary use of antibiotics among this group of patients,” says Vik.
“But as long as we cannot identify which women need antibiotics to avoid complications, we cannot recommend treatment with ibuprofen alone,” she concludes.
- Vik, I. et.al: Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women—A double-blind, randomized non-inferiority tria. PLOS One. (2018)
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