NSAIDs Can Prevent Urinary Tract Infections in Women

New research suggests over-the-counter painkillers could help prevent recurring infections that develop in women with urinary tract infections (UTI).

Washington University School of Medicine researchers found that, by inhibiting COX-2, an immune protein that causes inflammation, they were able to eliminate repeat urinary tract infections in mice. COX-2 can be blocked by non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen.

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In previous mouse studies, the Washington University investigators found the immune system overreacted to initial infections, suggesting increased vulnerability to infections that followed. In this study, the team found that immune cells, called neutrophils, contribute to repeat infections in both women and mice, leaving tracks in the protective lining of the bladder when they break in to fight infection.

This damage, according to the authors, can provide footholds that allow bacteria to attach to the bladder lining and initiative severe infections. By manipulating the strength of the neutrophil response in mice so that it was not too little or too much, the researchers were able to wipe out UTIs without increasing the risk of future infection.

The team also found that mice with increased vulnerability to recurring infections had more inflammatory molecules in their bladders, in comparison to mice what were not susceptible to repeat infections. However, the investigators observed these mice showed a greatly reduced vulnerability to repeat infections when treated with COX-2 inhibitors.

After examining the effect of COX-2 inhibitors on the immune response in the bladder, researchers determined that, while neutrophils still entered the bladder in large numbers, they caused much less damage to the protective lining. Thus, the investigators maintain that COX-2 inhibitors can selectively aim for the adverse effects of inflammation while keeping the beneficial responses.

“The use of NSAIDs or COX-2 inhibitors in the treatment or prevention of uncomplicated UTI in premenopausal women requires rigorous testing in large clinical trials,” says Tom Hannan, DVM, PhD, research instructor in pathology and immunology at the Washington University School of Medicine, and study co-author.

However, adds Hannan, “we envision that such painkillers could be used as a preventative during periods of high risk, such as times of sexual activity for women susceptible to post-coital UTI, and as an adjunct therapy during acute UTI in combination with commonly used antibiotics.”

The findings were presented at the annual meeting of the American Society for Microbiology, held May 17 – 20 in Boston, Mass.

—Mark McGraw