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The Research Question

This study aimed to determine if antibiotics are the only treatment option for urinary tract infection (UTI). The researchers conducted a randomized, controlled trial comparing the effectiveness of ibuprofen for symptomatic treatment and antibiotics only if needed, versus immediate antibiotic treatment with fosfomycin. The results showed that ibuprofen can substantially reduce the number of antibiotic prescriptions for women with UTI, although symptom resolution was slightly inferior compared to immediate antibiotic treatment. These findings suggest that symptomatic treatment can be considered for affected women.

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The Research Question

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  1. The Research Question Are antibiotics the only treatment option for urinary tract infection? – a comparative effectiveness trial Gágyor & J Bleidorn, K Wegscheider, G Schmiemann, M Kochen, E Hummers-Pradier • Can we reduce antibiotic prescriptions for uncomplicated urinary tract infection (UTI) by initial treatment with ibuprofen, reserving antibiotics to women with ongoing/worsening symptoms? • Why this is important? • UTI is common in family practice • UTI is known to be self-limiting in many cases • Guidelines recommend antibiotic treatment for UTI • Resistance rates of uropathogens are rising

  2. What the Researchers Did • Design: Randomized, controlled, double-blind trial comparing comparative effectiveness of: • Symptomatic treatment with ibuprofen, antibiotics only if needed (intervention) • Immediate antibiotic treatment with fosfomycin (control) • Participants: 494 women ≥ 18 and ≤ 65 years with typical UTI symptoms recruited in 42 family practices • Intervention: Ibuprofen (3x400 mg) for 3 days + placebo granules, antibiotics only if neededControl: Fosfomycin 3g granules 1x1 + 3x1 placebo for 3 days • Two co-primary outcomes (hypotheses): Number of antibiotic courses day 0-28 (superiority), disease burden: sum of the daily total symptom scores, day 0 to 7, (non-inferiority)

  3. What the Researchers Found • Antibiotic courses per patient • reduction by 69.0% in the ibuprofen group • Symptom burden (ratio of area under curve, AUC) • Non-inferiority margin in the ibuprofen group was missed (limit 125%) • AUCIbu/AUCFos = 140.5% (95% CI 125.4%-157.3%), p<0.001 • Similar symptom course in both groups • Complications: few cases only • More pyelonephritis, worsening, recurrent symptoms when treated with ibuprofen (non-significant) • More recurrent UTI in the fosfomycin group (p<0.049)

  4. What This Means for Clinical Practice • Changing treatment strategy towards initial symptomatic treatment can substantially reduce the number of antibiotic prescriptions for women with UTI. • Symptom resolution in the ibuprofen group was inferior, however both groups recovered within 7 days. • Based on these results symptomatic treatment can be discussed with affected women.

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