Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU)

Heltveit-Olsen, Silje Rebekka; Sundvall, Pär‐Daniel; Gunnarsson, Ronny; Arnljots, Egill Snaebjörnsson; Kowalczyk, Anna; Godycki-Ćwirko, Maciek; Platteel, Tamara N; Koning, Hilde A M; Groen, Wim G; Åhrén, Christina; Grude, Nils; Verheij, Theo; Hertogh, Cees M.P.M.; Lindbæk, Morten; Høye, Sigurd

doi:10.1136/bmjopen-2022-065217

Cited by 7 publications

(11 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…34,35 The ImpresU consortium is conducting a triple-blinded randomized control trial to evaluate whether the use of methenamine can effectively reduce rUTI. 36 or a placebo group (one placebo tablet twice a day) for 6 months with a 6-month follow-up period. Patients are contacted monthly by telephone during their active prophylaxis period, at the end of the prophylaxis period, and at the end of the study.…”

Section: Clinical Effectiveness and Safety Of Methenamine For Uti Pro...mentioning

confidence: 99%

“…Additional data are also needed to evaluate methenamine treatment durations greater than 12 months. Most studies were limited to 12 months or less, 3,[30][31][32][34][35][36][37] thus the clinical effectiveness and safety for longer periods is unclear. Methenamine is also not recommended to be given to patients who are concurrently receiving sulfonamides due to the risk of crystalluria.…”

Section: Use Of Methenamine In Renal Transplant Recipientsmentioning

confidence: 99%

“…One study instructed patients to take trimethoprim/sulfamethoxazole 12 h apart from methenamine to prevent any sulfonamide cross reactivity, which may be an effective strategy to mitigate this risk. 36 Although methenamine has been around for nearly 6 decades, clinical effectiveness and safety data are relatively limited.…”

Section: Use Of Methenamine In Renal Transplant Recipientsmentioning

confidence: 99%

“…3,[30][31][32][33][34][35][36][37][38]42 significant benefits compared to placebo (RR 1.54, 95%CI [0.38, 6.20]). This Cochrane review emphasized the need for large RCTs to better establish the effectiveness and safety of methenamine for long-term use in reducing UTIs, in both patients with and without renal abnormalities.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Methenamine for urinary tract infection prophylaxis: A systematic review

Li,

Cosler,

Harausz

et al. 2023

Pharmacotherapy

View full text Add to dashboard Cite

Urinary tract infections (UTIs) commonly affect many patient populations. Recurrent UTIs (rUTIs) can be particularly problematic and lead to potential hospitalizations, multiple antibiotic courses, and have a potential negative impact on quality of life. To prevent UTIs, antibiotics are frequently used for prophylaxis; however, antibiotic prophylaxis has notable untoward consequences including but not limited to potential adverse effects and development of antibiotic resistance. Methenamine, an antiseptic agent initially available in 1967, has re‐emerged as a potential option for UTI prophylaxis in various populations, including older adults and renal transplant recipients. The objective of this systematic review was to evaluate the clinical effectiveness and safety of methenamine for UTI prophylaxis. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidance was performed. A PubMed, Embase, and Cochrane library search was conducted to identify relevant English‐language studies evaluating methenamine for UTI prophylaxis including randomized controlled trials, case–control studies, and meta‐analyses through June 2023. Articles were excluded if the studies did not primarily describe or evaluate methenamine for UTI prophylaxis, were commentaries/viewpoints articles, point prevalence studies, review articles, studies that evaluated methenamine used with another agent, and any duplicate publications from searched databases. A total of 11 articles were identified for inclusion. This systematic review suggests methenamine generally appears to be an effective and well‐tolerated antibiotic‐sparing option for UTI prophylaxis. Furthermore, the pharmacology, dosage and formulation, warnings, precautions, and safety considerations of methenamine that provide potential clinical considerations regarding its use for UTI prophylaxis are described. Further studies are needed to evaluate the clinical utility of methenamine for UTI prophylaxis.

show abstract

Section: Clinical Effectiveness and Safety Of Methenamine For Uti Pro...mentioning

confidence: 99%

Section: Use Of Methenamine In Renal Transplant Recipientsmentioning

confidence: 99%

Section: Use Of Methenamine In Renal Transplant Recipientsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Methenamine for urinary tract infection prophylaxis: A systematic review

Li,

Cosler,

Harausz

et al. 2023

Pharmacotherapy

View full text Add to dashboard Cite

show abstract

“…Two recent trials, the alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women (ALTAR) trial [16 ▪ ] (an alternative to prophylactic antibiotics for the treatment of rUTIs in women) and the trial conducted by Botros et al in the US [15], have renewed interest in the use of methenamine hippurate as an alternative to low-dose daily antibiotic prophylaxis for the prevention of rUTIs in women. The ImpresU trial [17 ▪ ], which is being conducted in four Scandinavian nations, is being watched closely. It is a sizable phase IV, multicenter, triple-blind prospective RCT that compares methenamine with a placebo in older women, with results expected to be published in the second half of 2023.…”

Section: Introductionmentioning

confidence: 99%

The resurgence of methenamine hippurate in the prevention of recurrent UTIs in women- a systematic review

Kale¹,

Somani

2023

Current Opinion in Urology

View full text Add to dashboard Cite

Purpose of reviewRecurrent urinary tract infections (rUTIs) in women are prevalent and difficult to manage. The rise of antimicrobial resistance makes it prudent to re-investigate the role of nonantimicrobial agents in the prevention of RUTIs. We wanted to evaluate randomised controlled trials (RCTs) that employed methenamine hippurate as a therapy or prophylactic in adult women with rUTIs. Recent findingsRelevant databases were searched for RCTs using Cochrane methodology and reporting items for systematic reviews and meta-analyses (PRISMA) checklist, comparing the efficacy of methenamine hippurate to either an antibiotic or a placebo for the prophylaxis of rUTI in women. Six trials involving 322 patients taking methenamine and 419 patients receiving antibiotics in total were evaluated. The duration of the trials ranged from 12--24 months. Studies reported that methenamine was effective in extending the mean period between symptomatic episodes of urinary tract infections (UTIs), keeping the patient symptom-and infection-free, and reducing the number of UTI episodes. The newer studies reported that methenamine reduced the incidence rates of recurrent UTIs and was not inferior to the antibiotic in this regard.

show abstract

Effect of methenamine hippurate shortage on antibiotic prescribing for urinary tract infections in Norway—an interrupted time series analysis

Heltveit-Olsen,

Gopinathan,

Blix

et al. 2024

Journal of Antimicrobial Chemotherapy

Self Cite

View full text Add to dashboard Cite

Background Despite a lack of conclusive evidence of effect, methenamine hippurate is widely prescribed as preventive treatment for recurrent urinary tract infections (UTIs) in Norway. A national discontinuation of methenamine hippurate treatment due to a 4-month drug shortage in 2019 presented an opportunity to evaluate its preventive effect on UTIs among regular users. Objective To estimate the impact of the methenamine hippurate drug shortage on prescription frequency of UTI antibiotics. Methods Data from The Norwegian Prescription Database was analysed using an interrupted time series design. The time series consisted of 56 time periods of 14 days. The model included two naturally occurring interruptions: (i) the methenamine hippurate drug shortage, and (ii) reintroduction of the drug. The study population were 18 345 women ≥50 years receiving ≥2 prescriptions of methenamine hippurate in the study period before the shortage. Main outcome measure was number of prescriptions of UTI antibiotics per 1000 methenamine hippurate users. Prescription rates of antibiotics for respiratory tract infections were analysed to assess external events affecting antibiotic prescribing patterns. Results We found a significant increase of 2.41 prescriptions per 1000 methenamine hippurate users per 14-day period during the drug shortage (95%CI 1.39, 3.43, P < 0.001), followed by a significant reduction of −2.64 prescriptions after reintroduction (95%CI −3.66, −1.63, P < 0.001). Conclusions During the methenamine hippurate drug shortage, we found a significant increase in prescribing trend for UTI antibiotics followed by a significant decrease in prescribing trend after reintroduction. This change in trend seems to reflect a preventive effect of the drug on recurrent UTIs.

show abstract

Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU)

Cited by 7 publications

References 37 publications

Methenamine for urinary tract infection prophylaxis: A systematic review

Methenamine for urinary tract infection prophylaxis: A systematic review

The resurgence of methenamine hippurate in the prevention of recurrent UTIs in women- a systematic review

Effect of methenamine hippurate shortage on antibiotic prescribing for urinary tract infections in Norway—an interrupted time series analysis

Contact Info

Product

Resources

About