Is Non-Steroidal Anti-Inflammatory Therapy Non-Inferior to Antibiotic Therapy in Uncomplicated Urinary Tract Infections: a Systematic Review

• Published in: Journal of general internal medicine : JGIM Vol. 35; no. 6; pp. 1821 - 1829
• Main Authors: Carey, Matthew R., Vaughn, Valerie M., Mann, Jason, Townsend, Whitney, Chopra, Vineet, Patel, Payal K.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2020; Springer Nature B.V
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Anti-inflammatory agents; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antibiotics; Antimicrobial resistance; Bias; Clinical trials; Complications; Female; Humans; Infections; Inflammation; Internal Medicine; Medicine; Medicine & Public Health; Nonsteroidal anti-inflammatory drugs; Pyelonephritis; Randomization; Randomized Controlled Trials as Topic; Review Paper; Systematic review; Therapy; Urinary tract; Urinary tract diseases; Urinary tract infections; Urinary Tract Infections - drug therapy; Urogenital system; antibiotic stewardship; systematic review; antibiotics; NSAIDs; urinary tract infection
• DOI: 10.1007/s11606-020-05745-x
• ISSN: 0884-8734

Background Amid growing antimicrobial resistance, there is an increasing focus on antibiotic stewardship efforts to reduce inappropriate antibiotic prescribing. In this context, novel approaches for treating infections without antibiotics are being explored. One such strategy is the use of non-steroidal anti-inflammatory drugs (NSAIDs) for uncomplicated urinary tract infections (UTIs). Therefore, we conducted a systematic review of randomized controlled trials to evaluate the rates of symptom resolution and infectious complications in adult women with uncomplicated UTIs treated with antibiotics versus NSAIDs. Methods We systematically searched PubMed, CINHAL, Scopus, Web of Science Core Collection, EMBASE, and ClinicalTrials.gov from inception until January 13, 2020, for randomized controlled trials comparing NSAIDs with antibiotics for treatment of uncomplicated UTIs in adult women. Studies comparing symptom resolution between groups were eligible. Two authors screened all studies independently and in duplicate; data were abstracted using a standardized template. Risk of bias was assessed using the Cochrane Collaboration tool. Results Five randomized trials that included 1309 women with uncomplicated UTI met inclusion criteria. Three studies (1130 patients) favored antibiotic therapy in terms of symptom resolution. Two studies (179 patients) found no difference between NSAIDs and antibiotics in terms of symptom resolution. Three studies reported rates of pyelonephritis, two of which found higher rates in patients treated with NSAIDs versus antibiotics. Between two studies that reported this outcome (747 patients), patients randomized to NSAIDs received fewer antibiotic prescriptions compared with those in the antibiotics group. Three studies were at low risk of bias, one had an unclear risk of bias, and one was at high risk of bias. Discussion For the outcomes of symptom resolution and complications in adult women with UTI, evidence favors antibiotics over NSAIDs. Prospero CRD42018114133