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Use of Methenamine for Urinary Tract Infection Prophylaxis: Systematic Review of Recent Evidence

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Abstract

Introduction and Hypothesis

Antibiotic resistance is an unavoidable consequence of antibiotic use and growing rates of resistance are an urgent issue. Methenamine is a non-antibiotic alternative used for urinary tract infection (UTI) prophylaxis. The objective of this review is to evaluate recently published literature regarding the efficacy and safety of methenamine for UTI prophylaxis.

Methods

PubMed, Embase, and CENTRAL databases were queried in March 2023 using the following search terms: urinary tract infection, cystitis, bacteriuria, or dysuria, and methenamine. Studies prior to 2012 were excluded from this review to focus on appraisal of the most recent evidence. Prospective and controlled retrospective trials were included for review.

Results

A total of seven studies (three prospective and four retrospective) met the inclusion criteria for review. Two of the 3 prospective studies demonstrated no or non-inferior differences in clinical efficacy to prevent recurrent UTIs between methenamine and antibiotic prophylaxis and the third showed decreased rates of UTI with methenamine use in patients with short-term indwelling catheters compared with cranberry alone. The retrospective studies consistently supported the efficacy and safety of methenamine for UTI prophylaxis in a variety of populations and clinical settings. Adverse effects reported with methenamine were similar to comparators and included nausea, abdominal pain, and headache.

Conclusions

The use of methenamine for UTI prophylaxis was shown to be effective in a variety of settings without an increased risk of adverse effects compared with prophylactic antibiotics. Larger blinded clinical trials are needed to further define the role of methenamine in UTI prophylaxis.

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No funding was directed toward the creation of this manuscript.

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Author notes

  1. Jamie N. Brown

    Present address: Pharmacy Service, Durham VA Health Care System, 508 Fulton St. (119), Durham, NC, 27705, USA

Authors and Affiliations

  1. Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA

    Spencer M. Davidson

  2. Pharmacy Service, Durham VA Health Care System, 508 Fulton St. (119), Durham, NC, 27705, USA

    Clayton B. Nance & Mary L. Townsend

  3. Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA

    Jamie N. Brown

  4. Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA

    Mary L. Townsend

Authors
  1. Spencer M. Davidson
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  2. Jamie N. Brown
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Contributions

S.M. Davidson: project development, data collection, data analysis, manuscript writing, manuscript editing, final approval for publication; J.N. Brown: project development, data collection, data analysis, manuscript editing, final approval for publication; C.B. Nance: data analysis, manuscript editing, final approval for publication; M.L. Townsend: data analysis, manuscript editing, final approval for publication.

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Correspondence to Jamie N. Brown.

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Davidson, S.M., Brown, J.N., Nance, C.B. et al. Use of Methenamine for Urinary Tract Infection Prophylaxis: Systematic Review of Recent Evidence. Int Urogynecol J 35, 483–489 (2024). https://doi.org/10.1007/s00192-024-05726-2

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  • DOI: https://doi.org/10.1007/s00192-024-05726-2

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