Antibiotic resistance is rising and linked to prescribing in primary care. It is a national priority to try and reduce antibiotic prescribing where possible and resistance to antibiotics is a particular problem with cystitis (urinary tract infection). Cystitis in adult women is one of the most common conditions treated with antibiotics in primary care.

Although the symptoms are distressing they usually settle without complications within a few days. Antibiotics do shorten the duration of symptoms and treatment is currently the norm. An alternative strategy to delay the prescription for a few days has been successful in respiratory infections. In cystitis this results in a modest reduction in antibiotic prescribing but slightly prolonged symptoms. It is unlikely however that the delayed prescribing strategy will be widely adopted unless an alternative approach for symptom relief is available.

Two candidates for symptom relief have been identified:- Anti inflammatory drugs (NSAIDs) and a herbal product (Arctostaphylos Uva ursi). This study aims to find out if one or both of these products, alone or in combination, used during the period of delayed treatment would provide additional symptom relief. If so they would have the potential to change practice and to promote the delayed strategy in primary care and further reduce antibiotic prescribing. Women presenting to their GP with suspected cystitis will be asked to accept a delayed prescription for antibiotics and then to be randomised to one or both of the two medications to reduce symptoms. If their symptoms have not improved after 3-5 days or are getting worse then they will collect and take the antibiotics. We will record symptom severity using a diary and the proportion of women using antibiotics in each group.

The ATAFUTI trial will be led by Dr Michael Moore at the University of Southampton with additional recruitment Centres led by Dr Alastair Hay at the University of Bristol and Dr Michael Moore Dr Merlin Willcox at the University of Oxford.

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