Intended for healthcare professionals


Antibiotics or NSAIDs for uncomplicated urinary tract infection?

BMJ 2017; 359 doi: (Published 08 November 2017) Cite this as: BMJ 2017;359:j5037
  1. Paul Little, professor of primary care research
  1. University of Southampton
  1. p.little{at}

Pain relief and a delayed antibiotic prescription is a pragmatic and balanced approach

Urinary tract infection (UTI) is second only to respiratory tract infection in the use of antibiotics. It is an international priority to rationalise antibiotic use in primary care given the dangers of antibiotic resistance and the evidence that prescribing in primary care is likely to be a key driver of antibiotic resistance.1 The trial by Kronenberg and colleagues (doi:10.1136/bmj.j4784)2 provides a welcome addition to the literature, providing a head-to-head comparison of an antibiotic compared with a non-steroidal anti-inflammatory drug (NSAID, diclofenac) and extending the findings of a previous German trial of antibiotics compared with the NSAID ibuprofen.3

The results show that an initial prescription for antibiotics is superior to NSAIDs for symptomatic management and inferior in terms of net antibiotic usage. However, the difference in symptom control may not be as stark as the 27% absolute difference in symptom resolution by day 3 would suggest, since the reduction in symptom score …

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