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Methenamine hippurate for the management and prophylaxis of recurrent urinary tract infections: a scoping review
Abhisekh Chatterjee1, Iihan Ali2, Franklyn Wong2
1Imperial College School of Medicine, Imperial College London, London, UK abhisekh.chatterjee20@imperial.ac.uk.
Introduction:
Recurrent urinary tract infections (rUTIs) are typically treated using antibiotics. Given the growing issue of antimicrobial resistance, non-antibiotic management options for rUTIs have faced a recent resurgence in popularity. Methenamine hippurate is a urinary antiseptic used as a non-antibiotic prophylactic measure in those with rUTIs. The results of a recent randomised controlled trial showed methenamine hippurate to perform on par with antibiotic prophylaxis in adult women with rUTIs. However, little is known about the efficacy of methenamine hippurate in vulnerable patient populations, such as children, the elderly, patients with indwelling catheters and those with renal tract abnormalities. Moreover, an up-to-date, comprehensive evaluation of the entirety of the literature surrounding methenamine hippurate has yet to be carried out. As such, key trends within the literature, such as common side effects and specific avenues for future research, are difficult to determine. Therefore, we developed the methodology for a scoping review to map the entirety of the existing evidence base for methenamine hippurate.
Methods And Analysis:
The protocol for this scoping review was developed in accordance with the framework set out by Arksey and O'Malley. We will search MEDLINE, Embase, Scopus, the Cochrane Central Register of Controlled Trials and ProQuest Dissertation and Theses from inception until August 2024, with no language restrictions applied. Studies including patients of any age and sex receiving methenamine hippurate treatment, either as a primary or adjunct treatment for rUTIs, will be eligible for inclusion. Interventional studies, such as randomised controlled trials and their protocols, non-randomised clinical trials, cohort studies, case-control studies and observational studies of any design, will be included. Grey literature, systematic reviews and qualitative studies will also be included. Two independent reviewers blinded to each other's decisions will assess the eligibility of articles at each stage using the Covidence review platform. After the relevant data from each study has been extracted, we will report the results of our scoping review using descriptive summary statistics and a narrative thematic analysis.
Ethics And Dissemination:
Due to the nature of the present study, ethical approval was not required for this scoping review. The final manuscript of this scoping review will be published in an international, peer-reviewed journal and the findings of the review presented in relevant national and international conferences.
Insights
This scoping review outlines the methodology for evaluating methenamine hippurate as a non-antibiotic treatment for recurrent urinary tract infections (rUTIs). It aims to map existing evidence and identify research gaps for this important rUTI management option.
Area of Science:
- Urology
- Infectious Diseases
- Evidence Synthesis
Background:
- Recurrent urinary tract infections (rUTIs) pose a significant health challenge, with increasing antimicrobial resistance necessitating alternative treatments.
- Methenamine hippurate is a non-antibiotic urinary antiseptic gaining attention for rUTI prophylaxis.
- Current evidence on methenamine hippurate's efficacy is limited, particularly in vulnerable populations.
Purpose of the Study:
- To conduct a comprehensive scoping review of the existing literature on methenamine hippurate for rUTIs.
- To map the evidence base, identify common side effects, and highlight future research directions.
- To provide an up-to-date evaluation of methenamine hippurate as a non-antibiotic management option.
Main Methods:
- Protocol developed following Arksey and O'Malley framework.
- Searches across multiple databases (MEDLINE, Embase, Scopus, etc.) until August 2024, with no language restrictions.
- Inclusion of diverse study designs (RCTs, cohort, observational) and grey literature for comprehensive evidence mapping.
Main Results:
- Data extraction and analysis will utilize descriptive statistics and narrative thematic analysis.
- Two independent reviewers will assess study eligibility using Covidence.
- The review will synthesize findings on methenamine hippurate's efficacy, safety, and application in various patient groups.
Conclusions:
- This scoping review will provide a comprehensive overview of methenamine hippurate for rUTIs.
- It will identify knowledge gaps and guide future research in non-antibiotic UTI management.
- The findings will inform clinical practice and policy regarding methenamine hippurate use.
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