***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Study question Can treatment of the symptoms of uncomplicated urinary tract infection ( UTI ) with ibuprofen reduce the rate of antibiotic prescriptions without a significant increase in symptoms , recurrences , or complications ? Methods Women aged 18 - 65 with typical symptoms of UTI and without risk factors or complications were recruited in 42 German general practice s and r and omly assigned to treatment with a single dose of fosfomycin 3 g ( n=246 ; 243 analysed ) or ibuprofen 3 × 400 mg ( n=248 ; 241 analysed ) for three days ( and the respective placebo dummies in both groups ) . In both groups additional antibiotic treatment was subsequently prescribed as necessary for persistent , worsening , or recurrent symptoms . The primary endpoints were the number of all courses of antibiotic treatment on days 0 - 28 ( for UTI or other conditions ) and burden of symptoms on days 0 - 7 . The symptom score included dysuria , frequency/urgency , and low abdominal pain . Study answer and limitations The 248 women in the ibuprofen group received significantly fewer course of antibiotics , had a significantly higher total burden of symptoms , and more had pyelonephritis . Four serious adverse events occurred that lead to hospital referrals ; one of these was potentially related to the trial drug . Results have to be interpreted carefully as they might apply to women with mild to moderate symptoms rather than to all those with an uncomplicated UTI . What this paper adds Two thirds of women with uncomplicated UTI treated symptomatically with ibuprofen  recovered without any antibiotics . Initial symptomatic treatment is a possible approach to be discussed with women willing to avoid immediate antibiotics and to accept a somewhat higher burden of symptoms . Funding , competing interests , data sharing German Federal Ministry of Education and Research ( BMBF ) No 01KG1105 . Patient level data are available from the corresponding author . Patient consent was not obtained but the data are anonymised and risk of identification is low . Trial registration No Clinical TrialGov Identifier NCT01488955 Background Uncomplicated lower urinary tract infections ( UTI ) are usually treated with antibiotics . However , there is little evidence for alternative therapeutic options . This pilot study was set out 1 ) to make a rough estimate of the equivalence of ibuprofen and ciprofloxacin for uncomplicated urinary tract infection with regard to symptom resolution , and 2 ) to demonstrate the feasibility of a double-blind , r and omized controlled drug trial in German general practice s. Methods We performed a double-blind , r and omized controlled pilot trial in 29 German general practice s. Eighty otherwise healthy women aged 18 to 85 years , presenting with at least one of the main UTI symptoms dysuria and frequency and without any complicating factors , were r and omly assigned to receive either ibuprofen 3 × 400 mg oral or ciprofloxacin 2 × 250 mg ( + 1 placebo ) oral , both for three days . Intensity of main symptoms - dysuria , frequency , low abdominal pain - was recorded at inclusion and after 4 , 7 and 28 days , scoring each symptom from 0 ( none ) to 4 ( very strong ) . The primary endpoint was symptom resolution on Day 4 . Secondary outcomes were the burden of symptoms on Days 4 and 7 ( based on the sum score of all symptoms ) , symptom resolution on Day 7 and frequency of relapses . Equivalence margins for symptom burden on Day 4 were pre-specified as + /- 0.5 sum score points . Data analysis was done by intention to treat and per protocol . R and omization was carried out on patient level by computer programme in blocks of six . Results Seventy-nine patients were analyzed  ( ibuprofen n = 40 , ciprofloxacin n = 39 ) . On Day 4 , 21/36 ( 58.3 % ) of patients in the ibuprofen-group were symptom-free versus 17/33 ( 51.5 % ) in the ciprofloxacin-group . On Day 4 , ibuprofen patients reported fewer symptoms in terms of total sum score ( 1 ; SD 1,42 ) than ciprofloxacin patients ( 1,3 ; SD 1,9 ) , difference -0,33 ( 95 % CI ( -1,13 to + 0,47 ) ) , PP ( per protocol ) analysis . During Days 0 and 9 , 12/36 ( 33 % ) of patients in the ibuprofen-group received  secondary antibiotic treatment due to ongoing or worsening symptoms , compared to 6/33 ( 18 % ) in the ciprofloxacin-group ( non significant ) . A total of 58 non-serious adverse events were reported , 32 in the ibuprofen group versus 26 in the ciprofloxacin group ( non significant ) . Conclusions Our results support the assumption of non-inferiority of ibuprofen compared to ciprofloxacin for treatment of symptomatic uncomplicated UTI , but need confirmation by further trials . Trial registration Trial registration number : IS RCT N00470468See Commentary http://www.biomed central .com/1471 - Objectives To explore the views of women with urinary tract infection on the acceptability of different strategies for managing the infection , including delayed use of antibiotics , and the cause of infection . Design Qualitative interview study with semistructured one to one interviews within a r and omised controlled trial of different management strategies . Analysis drew on some of the principles of constant comparison to generate key themes grounded in reported experiences and underst and ings . Setting Seven general practice s across four counties in southern Engl and . Participants 21 women presenting to general practice s who were taking part in the larger trial . Results Women preferred not to take antibiotics and were open to alternative management approaches . With a strategy of “ antibiotic delay ” some women felt a lack of validation or that they were not listened to by their general practitioner . Women attributed urinary tract infection to lifestyle habits and behaviours , such as poor hygiene , general “ negligence , ” and even a “ penalty of growing old . ” Conclusion A clear acknowledgment of women ’s triggers to consult is needed . If women are asked to delay taking antibiotics , the clinician must address the particular worries that women might have and explain the rationale for not using antibiotics immediately OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of topical mometasone in children with bilateral otitis media with effusion ( OME ) . DESIGN A double-blind r and omised placebo-controlled trial with an intention to treat analysis ; the 10.6 % of patients lost to follow-up at 1 month were censored in the analysis . SETTING 76 Medical Research Council General Practice Research Framework practice s throughout the UK between 2004 and 2007 . PARTICIPANTS A sample of 217 children aged 4 - 11 years was selected from those presenting to their GP with one or more episodes of otitis media or ear-related problems in the previous 12 months whom the research nurse confirmed had bilateral glue ear using microtympanometry ( B B or B C2 types using a modified Jerger classification ) at r and omisation . INTERVENTIONS Mometasone 50 micrograms in each nostril or placebo spray once daily for 3 months . MAIN OUTCOME MEASURES The primary outcome was the proportions of children cleared of OME assessed by tympanometry at 1 month . Secondary outcomes included clearance at 3 months and 9 months ; adverse events ; OM8 - 30 scores ( a functional health status responsive disease-specific measure ) ; hearing loss ; days with otalgia ; cost-effectiveness ; and health utilities . RESULTS Of the topical steroid group , 40.6 % ( 39/96 ) demonstrated tympanometric clearance ( C1 or A type ) in one or both ears at 1 month , compared with 44.9 % ( 44/98 ) of the placebo group . The absolute risk reduction at 1 month was -4.3 % ( 95 % CI -18.05 % to 9.26 % ) ; the odds ratio ( OR ) was 0.84 ( 95 % CI 0.48 to 1.48 ) . Four covariates were pre-specified for inclusion in logistic regression analysis : age as a continuous variable ( p = 0.94 ) , season ( p = 0.70 ) , atopy ( p = 0.61 ) and clinical severity ( p = 0.006 ) . The adjusted OR ( AOR ) at 1 month for the main outcome was 0.93 ( 95 % CI 0.50 to 1.75 ) . Secondary analysis at 3 months showed 58.1 % of the steroid group had resolved and 52.3 % of the placebo group , AOR 1.45 ( 95 % CI 0.74 to 2.84 ) . At 9 months 55.6 % of the treated group remained clear in at least one ear and 65.3 % of the placebo group , AOR 0.82 ( 95 % CI 0.39 to 1.75 ) . Adverse events ( although relatively minor ) occurred in 7 - 22 % of children and included nasal stinging , epistaxis , dry throat and cough . The OM8 - 30 scores ( p = 0.55 ) reported hearing difficulty ( p = 0.08 ) , and days with otalgia ( p = 0.46 ) were not significantly different between groups at 3 months . The economic evaluation found the active treatment arm to be dominated by placebo , accruing slightly ( but not significantly ) higher costs and fewer quality -adjusted life-years ( QALYs ) , with a 24.2 % probability that topical steroids are a cost-effective use of NHS re sources at a ceiling ratio of 20,000 pounds per QALY gained . CONCLUSIONS Use of topical intranasal corticosteroids is very unlikely to be a clinical ly effective treatment for OME ( glue ear ) in the primary care setting . TRIAL REGISTRATION Current Controlled Trials IS RCT N38988331 Purpose Non-steroidal anti-inflammatory drugs ( NSAIDs ) are frequently prescribed or used as self-medication in cases of community-acquired pneumonia ( CAP ) . Nevertheless , the consequences of such medication on the risk of pleuroparenchymal complications are not well known . The aim was to investigate whether exposure to NSAIDs prior to hospital admission among patients suffering from CAP is associated with the development of pleural complications or a lung abscess . Methods All consecutive non-immunocompromised patients with CAP and admitted to a university hospital were prospect ively included ( 2-year period ) . The risk of pleuropulmonary complications was analyzed according to previous exposure to NSAIDs . Results Of the 221 included patients , 40 ( 18.1 % ) had developed a pleuropulmonary complication . NSAIDs intake prior to admission was reported for 24 patients ( 10.9 % ) who were younger ( 50.6 ± 18.5 vs. 66.5 ± 16.4 years ; p = 0.001 ) , had less comorbidities ( 60 vs. 25.1 % ; p = 0.001 ) , had a longer duration between the first symptoms of CAP and the start of an antibiotic therapy ( 6.1 ± 7.6 vs. 2.8 ± 3.8 days ; p = 0.001 ) , and who had a higher incidence of pleuropulmonary complications ( 33.3 vs. 16.2 % ; p = 0.048 ) . In multivariate analyses , two factors were independently associated with the development of pleuroparenchymal complications :  NSAIDs intake [ Odds Ratio ( OR ) = 2.57 [ 1.02–6.64 ] ; p = 0.049 ] and alcohol abuse ( OR = 2.68 [ 1.27–5.69 ] ; p = 0.01 ) . Conclusions Our findings suggest that NSAIDs , often taken by young and healthy patients , may worsen the course of CAP with delayed therapy and a higher rate of pleuropulmonary complications Background Women presenting with symptoms of acute uncomplicated urinary tract infection ( UTI ) are often prescribed antibiotics . However , in 25 to 50 % of symptomatic women not taking antibiotics , symptoms recover spontaneously within one week . It is not known how many women are prepared to delay antibiotic treatment . We investigated how many women presenting with UTI symptoms were willing to delay antibiotic treatment when asked by their general practitioner ( GP ) . Methods From 18 April 2006 until 8 October 2008 , in a prospect i ve cohort study , patients were recruited in 20 GP practice s in and around Amsterdam , the Netherl and s. Healthy , non-pregnant women who contacted their GP with painful and /or frequent micturition for no longer than seven days registered their symptoms and collected urine for urinalysis and culture . GPs were requested to ask all patients if they were willing to delay antibiotic treatment , without knowing the result of the culture at that moment . After seven days , patients reported whether their symptoms had improved and whether they had used any antibiotics . Results Of 176 women , 137 were asked by their GP to delay antibiotic treatment , of whom 37 % ( 51/137 ) were willing to delay . After one week , 55 % ( 28/51 ) of delaying women had not used antibiotics , of whom 71 % ( 20/28 ) reported clinical 
    Output:
    
For the outcomes of symptom resolution and complications in adult women with UTI , evidence favors antibiotics over NSAIDs .
