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Table 1 Study characteristics of NSAID versus Antibiotic use in Uncomplicated UTI

From: Symptomatic treatment (using NSAIDS) versus antibiotics in uncomplicated lower urinary tract infection: a meta-analysis and systematic review of randomized controlled trials

First author, year Study design, location Study population Inclusion criteria Exclusion criteria NSAID vs Antibiotic Outcomes
Bleidorn, 2010 Multicenter, double-blinded, RCT, pilot trial, Germany Non-pregnant women aged 18–85 y/o, with uncomplicated UTI At least one of the main UTI symptoms dysuria and frequency Signs of upper UTI symptoms (fever, back pain)
Pregnancy
Comorbidities: DM, CKD
GIT abnormalities or past urinary surgery, Urine catheterization, immunosuppressive therapy
UTI within the last two weeks
Current use of antibiotics or NSAIDs;
History of GI ulcers
Epilepsy
Allergies
Ibuprofen vs Ciprofloxacin Primary: Symptom resolution on Day 4
Secondary: Burden of symptoms on Day 4 and, symptom resolution on Day 7 and frequency of relapses until Day 28, and incidence of adverse events
Gagyor, 2015 Multicenter, double-blinded, RCT, Germany Non-pregnant women aged 18–65 y/o, with uncomplicated UTI Dysuria and/or frequency/urgency of micturition, with or without lower abdominal pain Any signs of upper UTI (fever, loin tenderness);
Pregnancy
Renal diseases
UTI within the past two weeks
Urinary catheterization. Recent NSAID or antibiotics use
History of GI ulcers or severe acute or exacerbated chronic conditions
Ibuprofen vs Fosfomycin Primary: Number of all courses of antibiotic treatment on Day 0–28, Burden of symptoms on Day 0 to 7
Secondary: Number of severe adverse events, complications, relapses up to Day 28, and within 6 and 12 months, women without symptoms at day 4 and 7, symptom load until Day 4, activity impairment on Day 1–7
Kronenberg, 2017 Multicenter, double-blinded, RCT, Switzerland Non-pregnant women aged 18–70 y/o, with uncomplicated UTI One or more symptoms or signs typical of acute lower UTI (dysuria, frequency, macrohematuria, cloudy or smelly urine) or self-diagnosed symptomatic cystitis (urine dipstick was positive for nitrite or leucocytes, or both) Pregnant women and women
Signs of upper UTI: (fever, costovertebral pain or tenderness, rigors, and nausea or vomiting)
GIT abnormalities
Comorbidities (DM, GI ulcer, IBD, liver cirrhosis, CKD, CHF)
Psychiatric illness or dementia
Documented immunosuppression
Hypersensitivity reactions
Women with vaginal symptoms (discharge, irritation)
Bladder catheterization
Recurrent UTI
Antibiotic treatment during the past four weeks
UTI symptoms > 7 days
Diclofenac vs Norfloxacin Primary: Resolution of symptoms at day 3
Secondary: Use of any antibiotic up to Day 30, resolution of symptoms on Day 7, complete absence of symptoms on Days 3 and 7, use of rescue antibiotic up to Day 3, negative urine culture result on Day 10, reconsultations because of UTI up to day 30, adverse events, serious adverse events, European quality of life.
Vik, 2018 Multicenter, double-blinded, noninferiority, RCT, Norway, Denmark, Sweden Non-pregnant women aged 18–60 y/o, with uncomplicated UTI Dysuria combined with either increased urinary frequency or urinary urgency or both, with or without visible hematuria Signs of upper UTI (fever, upper back pain)
UTI symptoms for > 7 days
Allergies/adverse reactions to penicillin or ibuprofen
Breastfeeding a child under 1 month of age
Vaginal irritation/discharge
Comorbids: diabetes; kidney disease; genetic aciduria; severe gastritis; ulcerative colitis; Crohn’s disease; low platelets);
Immunosuppressive therapy, or blood-thinning drugs
Previous pyelonephritis
Urinary catheterization
Symptoms of a UTI within the last 4 weeks
Antibiotic use within the last 2 weeks
Ibuprofen vs Pivmecillinam Primary: Proportion of patients who felt cured by Day 4
Secondary: Proportion of patients in need of secondary treatment with antibiotics, proportion of patient with positive second urine culture, in need of a medical consultation within 4 weeks of follow-up, cases of pyelonephritis