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

Matthew R Carey; Valerie M Vaughn; Jason Mann; Whitney Townsend; Vineet Chopra; Payal K Patel

doi:10.1007/s11606-020-05745-x

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

J Gen Intern Med. 2020 Jun;35(6):1821-1829. doi: 10.1007/s11606-020-05745-x. Epub 2020 Apr 8.

Authors

Matthew R Carey¹, Valerie M Vaughn^{1

2

3

4}, Jason Mann⁴, Whitney Townsend⁵, Vineet Chopra^{1

2

3

4}, Payal K Patel^{6

7

8

9}

Affiliations

¹ University of Michigan Medical School, Ann Arbor, MI, USA.
² Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.
³ Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
⁴ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
⁵ Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA.
⁶ University of Michigan Medical School, Ann Arbor, MI, USA. payalkp@med.umich.edu.
⁷ Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. payalkp@med.umich.edu.
⁸ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. payalkp@med.umich.edu.
⁹ Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA. payalkp@med.umich.edu.

Abstract

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.

Keywords: NSAIDs; antibiotic stewardship; antibiotics; systematic review; urinary tract infection.

Publication types

Review
Systematic Review

MeSH terms

Adult
Anti-Bacterial Agents / therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Female
Humans
Randomized Controlled Trials as Topic
Urinary Tract Infections* / drug therapy

Substances

Anti-Bacterial Agents
Anti-Inflammatory Agents, Non-Steroidal