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Antiseptic drug 'as good as antibiotics'

Thursday March 10th 2022

Methenamine hippurate, an antiseptic drug, could help to tackle antibiotic resistance associated with urinary tract infections, researchers report today.

The new research says it is as effective as antibiotics for preventing recurrent urinary tract infections in women.

Research, led by clinicians and scientists from Newcastle-upon-Tyne, UK, and published in The BMJ, tested if methenamine hippurate is an effective alternative to standard antibiotic treatment for preventing recurrent UTI in women.

Recurrent is defined as at least three repeated infections per year or two infections in the preceding six months.

Previous studies have shown that methenamine hippurate, which sterilises urine and stops the growth of certain bacteria, could be effective in preventing UTIs. However, the evidence was inconclusive.

For this study, the team examined 240 women, aged 18 or over, who had presented with more than six UTI episodes a year and all needed prophylactic treatment.

The women were recruited from UK secondary care centres between June 2016 and June 2018 and 102 were randomly assigned to have daily antibiotics and 103 were prescribed daily methenamine hippurate for 12 months. All had three monthly assessments up to 18 months.

During the 12-month treatment period, the UTI rate was 0.89 episodes per person year in the antibiotic group and 1.38 in the methenamine group - an absolute difference of 0.49 episodes per person year.

As the difference between the two groups was less than the predefined threshold of one UTI episode per year, it suggested that methenamine was no worse than antibiotics at preventing urinary tract infection.

Methenamine was also associated with reduced antibiotic consumption and similar levels of adverse reactions and treatment satisfaction compared to daily antibiotics.

The researchers acknowledge that there are little data on long-term safety of methenamine hippurate and add there were some trial limitations, including lack of blinding and differences in antibiotics prescribed, which could have affected the results.

However, they say their results “could support a change in practice in terms of preventive treatments for recurrent UTI and provide patients and clinicians with a credible alternative to daily antibiotics, giving them the confidence to pursue strategies that avoid long-term antibiotic use”.

Their findings “might encourage patients and clinicians to consider methenamine hippurate as a first line treatment for UTI prevention in women,” they add.

Harding C, Mossop H, Homer T et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ 10 March 2022; doi: 10.1136/bmj-2021-068229

[abstract]

Tags: Pharmaceuticals | UK News | Women's Health & Gynaecology

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