Nonantibiotic Prophylaxis Noninferior for Recurrent UTI

THURSDAY, March 10, 2022 (HealthDay News) — Nonantibiotic prophylaxis with methenamine hippurate is noninferior to prophylactic antibiotic treatment for women with recurrent urinary tract infection, according to a study published online March 9 in The BMJ.

Chris Harding, M.D., from Freeman Hospital in Newcastle upon Tyne, England, and colleagues conducted a multicenter, open-label, noninferiority trial at eight centers in the United Kingdom, recruiting women aged 18 years or older with recurrent urinary tract infections requiring prophylactic treatment from June 2016 to June 2018. Participants were randomly assigned to receive either antibiotic prophylaxis or methenamine hippurate for 12 months (120 women in each group).

The modified intention-to-treat analysis included 205 participants (102 and 103 in the antibiotic and methenamine hippurate groups, respectively). The researchers found that during the 12-month treatment period, the incidence of antibiotic-treated urinary tract infections was 0.89 and 1.38 episodes per person year in the antibiotics and methenamine hippurate groups, respectively, with an absolute difference of 0.49, confirming noninferiority. Adverse reactions were reported by 24 and 28 percent of patients in the antibiotic and methenamine hippurate groups, respectively, and were mostly mild.

“We have demonstrated high levels of efficacy from methenamine hippurate in terms of urinary tract infection prevention, and have shown that this efficacy is comparable to the current guideline recommended prophylaxis (that is, long course, low-dose antibiotic treatment),” the authors write.

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