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

Carolyn Botros, Svjetlana Lozo, Shilpa Iyer, Alexandra Warren, Roger Goldberg, Janet Tomezsko, Karen Sasso, Peter Sand, Adam Gafni-Kane, Adam Biener, Sylvia Botros-Brey

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
JournalInternational Urogynecology Journal
DOIs
StateAccepted/In press - 2021

Keywords

  • Antimicrobial stewardship
  • Bacteriuria
  • Urinary tract infection
  • Women’s health

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Urology

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