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Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial

BMJ 2015; 351 doi: (Published 23 December 2015) Cite this as: BMJ 2015;351:h6544

Rapid Response:

Is it rational to compare ibuprofen with fosfomycin? Relief of Symptoms and Cure of Infection are different aspects of treatment

Uncomplicated urinary tract infections are common in women and are usually treated with antibiotics (1). Evidence from the study shows that trimethoprim-sulfamethoxazole and nitrofurantoin remain first-choice empirical therapy for uncomplicated UTIs and fluoroquinolones should remain a second-line choice for treatment; also guidelines have been developed but their usefulness is little because of conflicting recommendations (1).

In this research, the trial authors concluded that initial treatment with ibuprofen was less effective for symptom relief in women aged 18-65 with mild to moderate symptoms of uncomplicated urinary tract infection, substantially reduced antibiotic use and there were more cases of pyelonephritis as compared with fosfomycin (2).

Fosfomycin is a broad-spectrum antibiotic which acts by inhibiting bacterial cell wall synthesis with useful activity against uropathogen E. coli (3). Hence the superiority of fosfomycin and other antibacterial drugs in the treatment of uncomplicated urinary tract infection in women is difficult to ignore.

Which treatment strategy for women with symptoms of urinary tract infection? (4) The report from a prospective cohort study is that women with symptoms of uncomplicated urinary tract infection are often willing to delay antibiotic treatment (5). However, empirical delayed prescription can help to reduce antibiotic use (6).

An open question with regards to Pharmacology Principle:

Is it rational to compare analgesic anti-inflammatory drugs like ibuprofen with antibiotics like fosfomycin, because relief of symptoms and cure of infection are different aspects of treatment.

With regards

1. Lindsay Nicolle, Peter A.M. Anderson, John Conly, Thomas C. Mainprize, Jamie Meuser, J. Curtis Nickel, Vyta M. Senikas, George G. Zhanel. Uncomplicated urinary tract infection in women: Current practice and the effect of antibiotic resistance on empiric treatment.Can Fam Physician. 2006 May 10; 52(5): 612–618.
2. BMJ 2015;351:h6544
3. Maraki S, Samonis G, Rafailidis PI, Vouloumanou EK, Mavromanolakis E, Falagas ME. Susceptibility of urinary tract bacteria to fosfomycin. Antimicrob. Agents Chemother. 2009:53(10);4508-4510.
4. BMJ 2015;351:h6888
5. BMC Fam Pract 2013;14: 71.doi:10.1186/1471-2296-14-71
6. BMJ 2010;340: c199. doi:10.1136/bmj.c199

Competing interests: No competing interests

02 January 2016
Dr. Rajiv Kumar
Professor, Deptt. of Pharmacology,
Government Medical College & Hospital, Chandigarh 160030. INDIA