ATAFUTI: Alternative Treatments of Adult Female Urinary Tract Infection: a double blind, placebo controlled, factorial randomised trial of Uva ursi and open pragmatic trial of ibuprofen

Problem

Antibiotic resistance is rising and linked to prescribing in primary care. Urinary tract infections (UTIs) are one of the most common female conditions treated by general practitioners (GPs), and the majority of patients are prescribed antibiotics. Antibiotics do speed symptom resolution but only by about 1 day. A delayed prescription strategy has been successful in respiratory infections and has been shown to be feasible in UTI but 77% of those asked to delay still used antibiotics. Those who present are in discomfort and it is unlikely delayed prescribing will become widespread unless effective symptom relief can be provided.

Aims: To evaluate whether Uva ursi, a herbal extract, or advice to take ibuprofen provides relief from urinary symptoms and reduces antibiotic use in adult women with a suspected UTI.

Approach

ATAFUTI was a double blind, placebo controlled, factorial randomised trial of Uva ursi and open pragmatic trial of ibuprofen advice. Adult women presenting with a suspected lower urinary infection who were prepared to accept a delayed prescription for antibiotics were recruited in primary care. Participants were randomised to one of four groups - Uva ursi + Advice to take ibuprofen; Uva ursi placebo + Advice to take ibuprofen: Uva ursi + No advice to take ibuprofen; Uva ursi placebo + No advice to take ibuprofen. All participants were issued with a prescription for delayed antibiotics. Participants were asked to take the study medication 3 times a day for three days or up to five days and to delay using their antibiotic prescription unless symptoms worsened.

Primary outcome: Symptom severity on days 2-4 from a self-completed symptom diary

Secondary outcome: Antibiotic use

A notes review was undertaken to look for re-consultations with a UTI in the 3 months following randomisation.

Findings

Recruitment took place between August 2015 and October 2016 from 57 practices in England; 382 women were recruited and follow up will complete in February 2017.

Primary analysis results will be presented at the conference.

Consequences

If the results are positive, this would have the potential to change practice and to promote the delayed strategy in primary care and further reduce antibiotic prescribing.