Methenamine hippurate compared with trimethoprim for the prevention of recurrent urinary tract infections: a randomized clinical trial

Botros, Carolyn; Lozo, Svjetlana; Iyer, Shilpa; Warren, Alexandra; Goldberg, Roger P.; Tomezsko, Janet; Sasso, Karen; Sand, Peter K.; Gafni-Kane, Adam; Biener, Adam; Botros-Brey, Sylvia

doi:10.1007/s00192-021-04849-0

Cited by 25 publications

(46 citation statements)

References 20 publications

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“…For example, because several antibiotics were used (trimethoprim, nitrofurantoin, or cefalexin) and subgroup analyses were uninformative, how methenamine hippurate compares with different antibiotics remains unknown. Although the results need cautious interpretation, they align with others,11 and this new research increases the confidence with which methenamine hippurate can be offered as an option to women needing prophylaxis against recurrent urinary tract infection.…”

supporting

confidence: 67%

Methenamine hippurate for recurrent urinary tract infections

Hoffmann

Bakhit

Mar

2022

BMJ

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supporting

confidence: 67%

Methenamine hippurate for recurrent urinary tract infections

Hoffmann

Bakhit

Mar

2022

BMJ

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“…RoB was high for one study, 11 and moderate for the remaining five (Appendix A). [1][2][3][4]8 Antibiotic Versus Methenamine Prophylaxis The 2019 review found low-strength evidence that rates of UTI recurrence were lower with antibiotic (nitrofurantoin or trimethoprim) than with methenamine prophylaxis, based on two trials with high RoB (Table B.1). One new study had moderate RoB, 8 and its results were inconsistent with the earlier evidence, showing no difference in efficacy between trimethoprim and methenamine.…”

Section: Resultsmentioning

confidence: 99%

“…Relevant Guideline Statement: 12, antibiotic prophylaxis New studies shaded blue; studies from 2019 review unshaded; statistically significant results in bold a Botros 2021 presented with Key Question 7 (non-antibiotic prophylaxis) in Updated Literature Review, but since methenamine was included as an antibiotic comparator in Question 6 of the 2019 report, we moved the study here to combine with earlier studies. A second citation, Botros 2020, reported the same study as a conference abstract only 21. Appendix A.…”

mentioning

confidence: 99%

Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline

et al. 2022

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Purpose:In 2019 the American Urological Association (AUA) released the evidence-based guideline “Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline.” Information supporting the guideline came from a 2019 systematic evidence review prepared for the AUA by the Pacific Northwest Evidence-based Practice Center (EPC). The AUA used evidence found for 11 Key Questions (Appendix C) in the EPC’s report to derive 16 Guideline Statements. In 2021 the EPC conducted an Update Literature Review (ULR) assessing abstracts from new studies published since the 2019 systematic review. The AUA asked the EPC to further assess a subset of studies included in the ULR report, to support potential changes to the 2019 guideline.Materials/Methods:A systematic-review utilized research from the Oregon Health & Science University. Pacific Northwest EPC was used to update the 2019 AUA Guideline on rUTI in women with new evidence published through 2021.Results:Updates were made to reflect changes in literature since 2019. Updates include recent publications on antibiotic prophylaxis, non-antibiotic prophylaxis, and estrogen therapy.Conclusion:The presence of rUTI is crucial to the health of patients and its effects must be considered for the welfare of society. This document will undergo updating as the knowledge regarding current treatments and future treatment options continues to expand.

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“…Patients received either methenamine or trimethoprim for ≥6 months; outcomes were evaluated 12 months after initiation of prophylaxis. Overall, 65% of patients in both treatment groups (28/43 in the methenamine group, 30/46 in the trimethoprim group) experienced UTI recurrences ( P = 0.98); thus, showing similar efficacy in the prophylaxis of rUTI [51].…”

Section: Prevention Of Ruti Using Non‐antibiotic Strategiesmentioning

confidence: 99%

Management of uncomplicated recurrent urinary tract infections

2021

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To discuss optimal management of recurrent urinary tract infections (UTIs) in women. About every second woman experiences at least one UTI in her lifetime, of those 30% experience another UTI, and 3% further recurrences. Especially young healthy women without underlying anatomical deficiencies suffer from recurrent UTIs (rUTI), which are associated with significant morbidity and reduction in quality of life. MethodsThis is a narrative review, investigating publications dealing with recurrent UTI in women. Risk factors and options for management are discussed. ResultsThe increased susceptibility of women to rUTI is based on the female anatomy in addition to behavioural, genetic, and urological factors. However, why some women are more likely than others to develop and maintain rUTI remains to be clarified. Invasive characteristics of certain uropathogenic Escherichia coli that are able to form extra-and intracellular biofilms and may therefore cause delayed release of bacteria into the bladder, may play a role in this setting. Treatment recommendations for an acute episode of rUTI do not differ from those for isolated episodes. Given the nature of rUTI, different prophylactic approaches also play an important role. Women with rUTI should first be counselled to use nonantibiotic strategies including behavioural changes, anti-adhesive treatments, antiseptics, and immunomodulation, before antibiotic prophylaxis is considered. In addition to the traditional treatment and prophylactic therapies, new experimental strategies are emerging and show promising effects, such as faecal microbiota transfer (FMT), a treatment option that transfers microorganisms and metabolites of a healthy donor's faecal matter to patients using oral capsules, enemas, or endoscopy. Initial findings suggest that FMT might be a promising treatment approach to interrupt the cycle of rUTI. Furthermore, bacteriophages, infecting and replicating in bacteria, have been clinically trialled for UTIs. ConclusionDue to the limitation of available data, novel treatment options require further clinical research to objectify the potential in treating bacterial infections, particularly UTIs.

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Methenamine hippurate compared with trimethoprim for the prevention of recurrent urinary tract infections: a randomized clinical trial

Cited by 25 publications

References 20 publications

Methenamine hippurate for recurrent urinary tract infections

Methenamine hippurate for recurrent urinary tract infections

Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline

Management of uncomplicated recurrent urinary tract infections

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