Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

A Commentary to this article was published on 06 July 2021

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Eells SJ, Bharadwa K, McKinnell JA, Miller LG. Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a Markov chain Monte Carlo model. Clin Infect Dis. 2014;58(2):147–60.

    Article  CAS  Google Scholar 

  2. Abdullatif A, Ahmed K, Zaman I, Khan MS, Dasgupta P. Recurrent urinary tract infections in women. Int Urogynecol J. 2015;26:795–804.

    Article  Google Scholar 

  3. Anger J, Lee U, Ackerman AL, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. J Urol. 2019;202(2):282–9.

    Article  Google Scholar 

  4. Geerlings SE, Beerepoot MA, Prins JM. Prevention of recurrent urinary tract infections in women: antimicrobial and nonantimicrobial strategies. Infect Dis Clin N Am. 2014;28(1):135–47.

    Article  Google Scholar 

  5. Mody L, Juthani-Mehta M. JAMA patient page. Urinary tract infections in older women. JAMA. 2014;311(8):874.

    Article  CAS  Google Scholar 

  6. Ikäheimo R, Siitonen A, Heiskanen T, et al. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis. 1996;22(1):91–9.

    Article  Google Scholar 

  7. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993;329(11):753–6.

    Article  CAS  Google Scholar 

  8. Eriksen B. A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women. Am J Obstet Gynecol. 1999;180(5):1072–9.

    Article  CAS  Google Scholar 

  9. Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev. 2004;3:CD001209.

    Google Scholar 

  10. Shepherd AK, Pottinger PS. Management of urinary tract infections in the era of increasing antimicrobial resistance. Med Clin North Am. 2013;97(4):737–57 xii.

    Article  Google Scholar 

  11. Epocrates. Search drugs: methenamine hippurate and trimethoprim. In Epocrates medical references (Version 21.4.1) [Mobile application software] 2020. Retrieved from http://itunes.apple.com.

  12. Kasanen A, Junnila SY, Kaarsalo E, Hajba A, Sundquist H. Secondary prevention of recurrent urinary tract infections. Comparison of the effect of placebo, methenamine hippurate, nitrofurantoin and trimethoprim alone. Scand J Infect Dis. 1982;14(4):293–6.

    Article  CAS  Google Scholar 

  13. Lee BS, Bhuta T, Simpson JM, Craig JC. Methenamine hippurate for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;17:10.

    Google Scholar 

  14. EAU Guidelines. Presented at the EAU Annual Congress Amsterdam the Netherlands 2020

  15. Epp A, Larochelle A, Urogynaecology Committee; Family Physicians Advisory Committee. Recurrent urinary tract infection. J Obstet Gynaecol Can. 2010;32(11):1082–101.

    Article  Google Scholar 

  16. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.

    Article  CAS  Google Scholar 

  17. Moon SJ, Lee WY, Hwang JS, Hong YP, Morisky DE. Accuracy of a screening tool for medication adherence: a systematic review and meta-analysis of the Morisky medication adherence Scale-8. PLoS One. 2017;12(11):e0187139.

    Article  Google Scholar 

  18. Kolman KB. Cystitis and pyelonephritis: diagnosis, treatment, and prevention. Prim Care. 2019;46(2):191–202.

    Article  Google Scholar 

  19. Pietropaolo A, Jones P, Moors M, Birch B, Somani BK. Effectiveness of antimicrobial Intravesical treatment for prophylaxis and treatment of recurrent urinary tract infections (UTI): a systematic review. Curr Urol Rep. 2018;19(10):78.

    Article  Google Scholar 

  20. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321.

    PubMed  Google Scholar 

  21. Schwenger EM, Tejani AM, Loewen PS. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst Rev. 2015;12:CD008772.

    Google Scholar 

  22. Kranjčec B, Papeš D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol. 2014;32(1):79–84.

    Article  Google Scholar 

  23. Yang B, Foley S. First experience in the UK of treating women with recurrent urinary tract infections with the bacterial vaccine Uromune®. BJU Int. 2018;121(2):289–92.

    Article  Google Scholar 

Download references

Funding

There was no source of financial support for this study.

Author information

Authors and Affiliations

  1. Lehigh Valley Health Network, 1611 Pond Road, Allentown, PA, 18104, USA

    Carolyn Botros

  2. Columbia University Medical Center, New York, NY, USA

    Svjetlana Lozo

  3. University of Chicago Medicine, Chicago, IL, USA

    Shilpa Iyer

  4. Central Michigan University College of Medicine, Mount Pleasant, MI, USA

    Alexandra Warren

  5. NorthShore University Health System, Skokie, IL, USA

    Roger Goldberg, Peter Sand & Adam Gafni-Kane

  6. Women’s Health Institute of Illinois, Skokie, IL, USA

    Janet Tomezsko & Karen Sasso

  7. Lafayette College, Easton, PA, USA

    Adam Biener

  8. University of Texas Health Science Center San Antonio, San Antonio, TX, USA

    Sylvia Botros-Brey

Authors
  1. Carolyn Botros
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Svjetlana Lozo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shilpa Iyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexandra Warren
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roger Goldberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Janet Tomezsko
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karen Sasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peter Sand
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Adam Gafni-Kane
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Adam Biener
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sylvia Botros-Brey
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

C. Botros: protocol/project development, data collection and management, data analysis, manuscript writing/editing; S. Lozo: data collection and management, manuscript editing; S. Iyer: protocol/project development, data collection, manuscript editing; A. Warren: data management, manuscript writing/editing; R. Goldberg: protocol/project development, data collection, manuscript editing; J. Tomezsko: protocol/project development, data collection, manuscript editing; K. Sasso: data collection and management, manuscript editing; P. Sand: protocol/project development, data collection, manuscript editing; A. Gafni-Kane: protocol/project development, data collection, manuscript editing; A. Biener: data analysis, manuscript editing; S. Botros-Brey: protocol/project development, data collection and management, manuscript writing/editing.

Corresponding author

Correspondence to Carolyn Botros.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix 1

Table 6 Multivariate regression; per-protocol analysis
Full size table

Appendix 2

Table 7 Multivariate regression; intent-to-treat analysis
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Botros, C., Lozo, S., Iyer, S. et al. Methenamine hippurate compared with trimethoprim for the prevention of recurrent urinary tract infections: a randomized clinical trial. Int Urogynecol J 33, 571–580 (2022). https://doi.org/10.1007/s00192-021-04849-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-021-04849-0

Keywords

Search

Navigation