Uncomplicated urinary tract infections (UTIs) are a common presentation in primary care, however there is increasing concern regarding antibiotic use and resistant organisms. In this double-blind randomised German study, the authors seek to establish if ibuprofen 400mg three times a day for three days was a viable alternative to fosfomycin 3g single dose in women aged 18-65 with typical urinary tract infection symptoms. Primary study endpoints were total number of courses of antibiotics within 28 days, and symptom burden up to day seven. Secondary endpoints included adverse events and relapse rates. Exclusion criteria included upper urinary tract infection and in situ catheters. In total 494 patients were recruited, 248 (241 analysed) in the ibuprofen group vs. 246 (243 analysed) in the fosfomycin group. The study demonstrated significantly lower numbers of antibiotic courses in the ibuprofen group: 81 for UTIs, 13 for other reasons compared with 243 at study induction, 34 additional courses for UTIs and six for other reasons in the fosfomycin group. However, there was a higher symptom burden in the ibuprofen group, with significantly higher rate of developing pyelonephritis. All symptom-related secondary endpoints favoured fosfomycin. One gastrointestinal bleed occurred in the ibuprofen group. It is notable that 67% of the ibuprofen group recovered without the need for antibiotic treatment. The authors had to reject the hypothesis of non-inferiority of initial symptomatic treatment, however it raises an area to explore in the search for alternatives to antibiotic therapy. It would be interesting to see a comparison with more commonly used antibiotics in UK practice.
