Uncomplicated lower urinary tract infection (UTI) is an infection in the bladder and urethra. Non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics are both used as the first-line treatment for uncomplicated UTIs, but their effectiveness is not well-studied. This study aims to analyze the efficacy of symptomatic treatment of uncomplicated lower UTIs with NSAIDs in comparison with the regular antibiotics.

This double-blind, non-inferiority, randomized trial included a total of 253 women with uncomplicated lower UTI. The patients were randomly assigned in a 1:1 ration to symptomatic treatment with diclofenac (NSAID) (n=133) or antibiotic treatment with norfloxacin (n=120). The primary outcome of the study was the resolution of symptoms 74 hours after randomization.

The findings suggested that symptomatic resolution occurred in 72 women (54%) in the diclofenac group and 96 (80%) in the norfloxacin group on day 3. The median time until resolution of symptoms was higher in the diclofenac group (4 days), as compared with the norfloxacin group (2 days). 62% of women in the diclofenac group and 98% in the norfloxacin group continued treatment for 30 days. Six patients (5%) in the diclofenac group suffered from pyelonephritis.

The research concluded that diclofenac was inferior to norfloxacin for symptomatic resolution. In addition, diclofenac was also associated with an increased risk of pyelonephritis.

Ref: https://www.bmj.com/content/359/bmj.j4784