Methenamine hippurate compared with trimethoprim for the prevention of recurrent urinary tract infections: a
Carolyn Botros1, Svjetlana Lozo2, Shilpa Iyer3
1Lehigh Valley Health Network, 1611 Pond Road, Allentown, PA, 18104, USA. carolynbotros@gmail.com.
Introduction And Hypothesis:
The objective was to find an alternative treatment to a low-dose antibiotic for the prevention of recurrent urinary tract infections (UTI) and to evaluate the difference in rates of reinfection within 1 year when treated with methenamine hippurate for prophylaxis compared with trimethoprim.
Methods:
We present a non-blinded randomized trial comparing methenamine hippurate with trimethoprim for the prevention of recurrent UTI at 12 months after starting treatment. Women over 18 who had at least two culture-positive UTI in the prior 6 months or three in the prior year were included. Ninety-two patients met enrollment criteria and were randomized to receive daily prophylaxis with methenamine hippurate or trimethoprim for a minimum of 6 months. Both intent-to-treat and per-protocol analyses if patients received the alternative drug after randomization were analyzed using Student's t test, Mann-Whitney U test, Kaplan-Meier curves, log-rank test, and a logistic and multivariate regression model. The primary outcome of this study was culture-proven UTI recurrence by 12 months after initiating prophylaxis.
Results:
In the intent-to-treat analysis, we found no difference between groups in recurrent UTI, with a 65% (28 out of 43) recurrence in the trimethoprim group versus 65% (28 out of 43) in the methenamine hippurate group (p = 1.00). In the per-protocol analysis, 65% (26 out of 40) versus 65% (30 out of 46) of patients had UTI recurrences in the trimethoprim group versus the methenamine hippurate group (p = 0.98).
Conclusions:
Methenamine hippurate may be an alternative for the prevention of recurrent UTI, with similar rates of recurrence and adverse effects to trimethoprim.
Insights
Methenamine hippurate is a viable alternative to trimethoprim for preventing recurrent urinary tract infections (UTI). Both treatments showed similar recurrence rates over one year in a randomized trial.
Area of Science:
- Urology
- Infectious Diseases
- Pharmacology
Background:
- Recurrent urinary tract infections (UTI) pose a significant health burden.
- Low-dose antibiotics are a common preventive treatment, but alternatives are sought to mitigate antibiotic resistance.
- Methenamine hippurate offers a potential alternative prophylactic agent.
Purpose of the Study:
- To evaluate methenamine hippurate as an alternative prophylactic treatment for recurrent UTIs.
- To compare the 1-year recurrence rates of UTI between methenamine hippurate and trimethoprim.
Main Methods:
- A non-blinded, randomized trial involving 92 women with recurrent UTIs.
- Participants received daily prophylaxis with either methenamine hippurate or trimethoprim for at least 6 months.
- Culture-proven UTI recurrence at 12 months was the primary outcome, analyzed using various statistical methods.
Main Results:
- No significant difference in UTI recurrence rates was observed between the methenamine hippurate and trimethoprim groups.
- Intent-to-treat analysis showed a 65% recurrence rate in both groups (p=1.00).
- Per-protocol analysis also revealed similar recurrence rates (p=0.98).
Conclusions:
- Methenamine hippurate demonstrates comparable efficacy to trimethoprim in preventing recurrent UTIs.
- It may serve as a suitable alternative prophylactic treatment.
- Similar recurrence and adverse effect profiles suggest its potential clinical utility.
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