This is the cover story of a recent issue of the BMJ. As per the World Health Organization (WHO), antibiotic resistance is becoming a major economic and global problem. This is a randomised, double-blind study from 17 general practices in Switzerland. Two hundred and fifty-three women with symptoms of urinary tract infection (UTI) were randomly allocated to two treatment groups – diclofenac or norfloxacin. The primary outcome was resolution of symptoms at day three. Fifty-four percent of women in the diclofenac group and 80% in the norfloxacin group got resolution on day three. Antibiotic consumption was reduced by 37% in group one. An uncomplicated lower UTI may resolve with diclofenac but two significant downsides are: a) symptoms may last longer; and b) there is an increased risk of pyelonephritis. In another similar study, Ibuprofen was found to be superior to diclofenac in preventing pyelonephritis. As necessary, patients may be given a delayed antibiotics prescription.

Antibiotics or NSAIDs for uncomplicated urinary tract infection?
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Arun K Sharma

West Herts NHS Trust (Watford General Hospital)

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