Methenamine hippurate compared with trimethoprim for the prevention of recurrent urinary tract infections: a randomized clinical trial
Document Type
Article
Publication Date
6-11-2021
Publication Title
International urogynecology journal
E-ISSN
1433-3023
Department(s)
Department of Obstetrics and Gynecology; Fellows and Residents
Keywords
Antimicrobial stewardship, Bacteriuria, Urinary tract infection, Women’s health
Abstract
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.
DOI
10.1007/s00192-021-04849-0
PubMed ID
34115162
Recommended Citation
Botros, C., Lozo, S., Iyer, S., Warren, A., Goldberg, R., Tomezsko, J., Sasso, K., Sand, P., Gafni-Kane, A., Biener, A., & Botros-Brey, S. (2021). Methenamine hippurate compared with trimethoprim for the prevention of recurrent urinary tract infections: a randomized clinical trial. LVHN Scholarly Works. Retrieved from https://scholarlyworks.lvhn.org/research-historical-works/54
DOI: 10.1007/s00192-021-04849-0