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Uva-ursi extract and ibuprofen as alternative treatments for uncomplicated urinary tract infection in women (ATAFUTI): a factorial randomized trial

Uva-ursi extract and ibuprofen as alternative treatments for uncomplicated urinary tract infection in women (ATAFUTI): a factorial randomized trial
Uva-ursi extract and ibuprofen as alternative treatments for uncomplicated urinary tract infection in women (ATAFUTI): a factorial randomized trial

Objectives: The aim was to investigate if offering symptomatic therapy (Uva-ursi or ibuprofen) alongside a delayed prescription would relieve symptoms and reduce the consumption of antibiotics for adult women presenting with acute uncomplicated urinary tract infection (UTI). Methods: A 2 × 2 factorial placebo controlled randomized trial in primary care. The participants were 382 women aged 18–70 years with symptoms of dysuria, urgency, or frequency of urination and suspected by a clinician to have a lower UTI. The interventions were Uva-ursi extract and/or ibuprofen advice. All women were provided with a delayed or ‘back-up’ prescription for antibiotics. Missing data were imputed using multiple imputation methods (ISRCTN registry: ISRCTN43397016). Results: An ITT analysis of mean score for frequency symptoms assessed on Days 2–4 found no evidence of a difference between Uva-ursi vs. placebo –0.06 (95% CI –0.33 to 0.21; p 0.661), nor ibuprofen vs. no ibuprofen advice –0.01 (95% CI –0.27 to 0.26; p 0.951). There was no evidence of a reduction in antibiotic consumption with Uva-ursi (39.9% vs. placebo 47.4%; logistic regression odds ratio (OR) 0.59 (95% CI 0.22–1.58; p 0.293) but there was a significant reduction for ibuprofen advice (34.9% vs. no advice 51.0%; OR 0.27 (95% CI 0.10 to 0.72; p 0.009). There were no safety concerns and no episodes of upper tract infection were recorded. Conclusions: We found no evidence of an effect of either intervention on the severity of frequency symptoms. There is evidence that advice to take ibuprofen will reduce antibiotic consumption without increasing complications. For every seven women given this advice, one less will use antibiotics.

Antibiotic resistance, Ibuprofen, NSAID, Urinary tract infection, Uva-ursi
1198-743X
1-8
Moore, M.
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Trill, J.
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Simpson, C.
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Webley, F.
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Radford, M.
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Stanton, L.
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Maishman, T.
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Galanopoulou, A.
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Flower, A.
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Eyles, C.
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Willcox, M.
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Hay, A. D.
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van der Werf, E.
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Gibbons, S.
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Lewith, G.
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Little, P.
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Griffiths, G.
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Moore, M.
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Trill, J.
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Simpson, C.
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Webley, F.
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Radford, M.
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Stanton, L.
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Maishman, T.
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Galanopoulou, A.
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Flower, A.
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Eyles, C.
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Willcox, M.
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Hay, A. D.
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van der Werf, E.
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Gibbons, S.
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Lewith, G.
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Little, P.
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Griffiths, G.
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Moore, M., Trill, J., Simpson, C., Webley, F., Radford, M., Stanton, L., Maishman, T., Galanopoulou, A., Flower, A., Eyles, C., Willcox, M., Hay, A. D., van der Werf, E., Gibbons, S., Lewith, G., Little, P. and Griffiths, G. (2019) Uva-ursi extract and ibuprofen as alternative treatments for uncomplicated urinary tract infection in women (ATAFUTI): a factorial randomized trial. Clinical Microbiology and Infection, 1-8. (doi:10.1016/j.cmi.2019.01.011).

Record type: Article

Abstract

Objectives: The aim was to investigate if offering symptomatic therapy (Uva-ursi or ibuprofen) alongside a delayed prescription would relieve symptoms and reduce the consumption of antibiotics for adult women presenting with acute uncomplicated urinary tract infection (UTI). Methods: A 2 × 2 factorial placebo controlled randomized trial in primary care. The participants were 382 women aged 18–70 years with symptoms of dysuria, urgency, or frequency of urination and suspected by a clinician to have a lower UTI. The interventions were Uva-ursi extract and/or ibuprofen advice. All women were provided with a delayed or ‘back-up’ prescription for antibiotics. Missing data were imputed using multiple imputation methods (ISRCTN registry: ISRCTN43397016). Results: An ITT analysis of mean score for frequency symptoms assessed on Days 2–4 found no evidence of a difference between Uva-ursi vs. placebo –0.06 (95% CI –0.33 to 0.21; p 0.661), nor ibuprofen vs. no ibuprofen advice –0.01 (95% CI –0.27 to 0.26; p 0.951). There was no evidence of a reduction in antibiotic consumption with Uva-ursi (39.9% vs. placebo 47.4%; logistic regression odds ratio (OR) 0.59 (95% CI 0.22–1.58; p 0.293) but there was a significant reduction for ibuprofen advice (34.9% vs. no advice 51.0%; OR 0.27 (95% CI 0.10 to 0.72; p 0.009). There were no safety concerns and no episodes of upper tract infection were recorded. Conclusions: We found no evidence of an effect of either intervention on the severity of frequency symptoms. There is evidence that advice to take ibuprofen will reduce antibiotic consumption without increasing complications. For every seven women given this advice, one less will use antibiotics.

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Accepted/In Press date: 16 January 2019
e-pub ahead of print date: 25 January 2019
Keywords: Antibiotic resistance, Ibuprofen, NSAID, Urinary tract infection, Uva-ursi

Identifiers

Local EPrints ID: 430385
URI: http://eprints.soton.ac.uk/id/eprint/430385
ISSN: 1198-743X
PURE UUID: d16c37ed-0de9-4d15-ba4b-99cfd124236e
ORCID for M. Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for L. Stanton: ORCID iD orcid.org/0000-0001-8181-840X
ORCID for M. Willcox: ORCID iD orcid.org/0000-0002-5227-3444
ORCID for G. Griffiths: ORCID iD orcid.org/0000-0002-9579-8021

Catalogue record

Date deposited: 26 Apr 2019 16:30
Last modified: 26 Nov 2021 03:10

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Contributors

Author: M. Moore ORCID iD
Author: J. Trill
Author: C. Simpson
Author: F. Webley
Author: M. Radford
Author: L. Stanton ORCID iD
Author: T. Maishman
Author: A. Galanopoulou
Author: A. Flower
Author: C. Eyles
Author: M. Willcox ORCID iD
Author: A. D. Hay
Author: E. van der Werf
Author: S. Gibbons
Author: G. Lewith
Author: P. Little
Author: G. Griffiths ORCID iD

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