Urotropine hippurate is effective in preventing recurrent urinary tract infections

This article is from the NEJM Journal Watch (NEJM Journal Watch) Methenamine Hippurate Works for Preventing Recurrent Urinary Tract Infections Urotropine Hippurate Effectively Prevents Recurrent Urinary Tract Infections Review by Bruce Soloway, MD Application of non-antibiotic antimicrobials may slow antibiotics Generation of resistance
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According to guidelines issued by the American Urological Association, recurrent urinary tract infections (UTIs) can be prevented with 1-year low-dose antibiotic therapy, but there are concerns that this could lead to antibiotic resistance (J Urol 2019; 202 :282)
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The non-antibiotic urinary tract antibacterial urotropine hippurate (hydrolyzed to bactericidal formaldehyde in the distal renal tubules) may be an effective alternative, but its efficacy has not been adequately studied
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In a pragmatic noninferiority trial, UK investigators randomly assigned 240 women with recurrent symptomatic UTIs (average of 7 episodes in the past 1 year) to receive daily low-dose antibiotic prophylaxis Medication (nitrofurantoin, trimethoprim, or cephalexin, as determined by the patient and clinician), and the other group received prophylactic urotropine hippurate (100 mg twice daily) for 12 months
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Patients can switch between different antibiotics or between two treatment strategies
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For patients with symptoms of a UTI, this trial recommends that they see their usual clinician for short-term antibiotic therapy
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In the modified intention-to-treat analysis, the incidence of symptomatic UTIs (with or without bacteriological confirmation) was higher in the urotropine hippurate group receiving antibiotics than in the antibiotic group (1.
38 vs.
0.
89 per patient-year), but the difference was not significant.
Confidence intervals did not exceed prespecified noninferiority limits (1 UTI per person-year)
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There were similar small differences between the two groups within 6 months after treatment ended
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Comments Urotropine hippurate appears to be a reasonable non-antibiotic alternative for patients with recurrent UTI
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Short-term studies of urotropine hippurate have shown few adverse effects, but its long-term safety has not been adequately evaluated
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Reviewed article Harding C et al.
Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: Multicentre, open label, randomised, non-inferiority trial.
BMJ 2022 Mar 9; 376:e068229.
(https://doi .
org/10.
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