TABLE 1

Randomized controlled trials of urinary tract infection treatment: Antibiotics vs placebo or delayed antibiotics

StudyaPatients and treatmentMeasures studiedOutcomes
Christiaens et al288 women, ages 15-54
Nitrofurantoin 100 mg or placebo four times a day for 3 days		Symptoms and urinalysis over 14 daysWomen who reported symptomatic cure (complete relief of symptoms) after 7 days:
 24 (70%) of 40 with nitrofurantoin
 14 (42%) of 38 with placebo
Women who reported symptomatic improvement (defined as "few symptoms") after 7 days:
 6 (18%) of 40 with nitrofurantoin
 3 (9%) of 38 with placebo
Bleidorn et al380 women, ages 18-85
Ibuprofen 400 mg three times a day vs ciprofloxacin 250 mg twice a day for 3 days		Symptoms and urinalysis over 28 daysSymptomatic improvement and cure after 4 days:
 21 (58.3%) of 36 with ibuprofen
 17 (51.5%) of 33 with ciprofloxacin
Receiving secondary antibiotic treatment due to ongoing or worsening symptoms by day 9:
 12 (33%) of 36 with ibuprofen
 6 (18%) of 33 with ciprofloxacin (not significant)
Little et al4309 women, ages 18-70
Immediate antibiotics vs 48-hour delay vs targeted antibiotics based on symptom severity, dipstick result, or positive midstream urine culture		Symptom severity at days 2-4
Rates of antibiotic use		Immediate antibiotic group had 3.5 days of moderately bad symptoms; most groups were similar; delayed antibiotic group reconsulted less (hazard ratio 0.57, 95% confidence interval 0.36-0.89, P= .014), but had symptoms for 37% longer than the immediate antibiotic group (incident rate ratio 1.37, 95% confidence interval 1.11–1.68, P= .003)
Rates of antibiotic use:
 Immediate antibiotic group97%
 Symptom severity group90%
 Urine culture group81%
 Urine dipstick group80%
 Delayed antibiotic group77% (P = .011)
Ferry et al51,143 women, ages 18 and olderSymptoms, bacteriuria, and urine culture over 7 weeksAssociations between symptoms, bacteriuria, and urine culture results were unpredictable
288 patients received placebo for 7 daysSpontaneous cure rates in the placebo group:
 28% symptom-free after the first week
 37% symptom-free, and no bacteriuria after 5–7 weeks
Limitation: 39% dropout rate
Gágyor et al6779 women, ages 18-65Symptoms and urinalysis over 28 days
Safety data collected every 6 months over 2 years		See text for more details
Ibuprofen 400 mg three times a day for 3 days vs a single 3-g dose of fosfomycinTwo-thirds of the women in the ibuprofen group recovered without antibiotic treatment
Within 28 days, 34% of the ibuprofen group received antibiotic treatment for persistent or worsening symptoms compared with 14% of the fosfomycin group (who received an additional course of antibiotics)
On days 0–4, patients in the ibuprofen group had more symptoms than those in the fosfomycin group

  • ↵a Participants in these studies were not pregnant.