Background: To investigate if offering symptomatic therapy alongside a delayed prescription would relieve symptoms and reduce the consumption of antibiotics for adult women presenting with acute uncomplicated urinary tract infection (UTI). Methods: A 2x2 factorial placebo controlled randomised trial in primary care. Participants 382 women aged 18-70 with symptoms of dysuria, urgency or frequency of urination and suspected by a GP or nurse practitioner to have a lower UTI. Interventions: Uva-ursi extract: containing 20% arbutin with a total daily dose of 3600 mg. Ibuprofen advice: A daily dose of 1200 mg was recommended or prescribed on request. All women were provided with a delayed or 'back-up' prescription for antibiotics. Findings: An ITT analysis of mean score for frequency symptoms found no evidence of a difference between Uva-ursi vs. placebo -0·06 (95% CI -0·33 to 0·21) p=0·661, nor ibuprofen vs. no ibuprofen advice -0·01 (95% CI -0·27 to 0·26) p=0·951. There was no evidence of a significant reduction in antibiotic consumption with Uva-ursi (39·9% vs. placebo 47·4%; logistic regression odds ratio (OR) 0·59 (95% CI 0·22 to 1·58) p=0·293) but a significant reduction for ibuprofen advice (ibuprofen advice 34·9% vs. no advice 51·0%; OR 0·27 (95% CI 0·10 to 0·72) p=0·009). There were no safety concerns and no episodes of upper tract infection were recorded. Interpretation: We found no evidence of an effect of either intervention on the severity of frequency symptom. However a substantial proportion of women willing to consider delaying antibiotics for UTI will not use the antibiotics, and there is evidence that advice to take ibuprofen will result in a significant reduction in antibiotic use without increasing the risks of complications. For every six women given this advice one less will use antibiotics. The clinical trial was coordinated by the Southampton Clinical Trials Unit, a UKCRC registered, NIHR support funded Clinical Trials Unit. The trial was sponsored by the University of Southampton and funded by the NIHR School of Primary Care. The trial had received favourable ethical approval and registered with the UK MHRA. Clinical Trial Number: Trial Registration Number: ISRCTN registry: ISRCTN43397016. Registered on 11 February 2015. Funding Statement: This project is funded by the National Institute for Health Research (NIHR) School of Primary Care, project number 170. The project is sponsored by the University of Southampton. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR School of Primary Care. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form online at icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: In compliance with the Helsinki declaration, the ATAFUTI trial has been granted ethical approval by the South Central – Hampshire Research Ethics Committee (REC, 14/SC/1143), and UK Medicines and Health Care Products Regulatory Agency (MHRA) (reference16730/0215/001-0001). Informed written consent was obtained from all participants.