Exploring the Efficacy of Methenamine Hippurate Across Different Patient Groups With Recurrent Urinary Tract Infections: Experience From a University Teaching Hospital in South Wales, United Kingdom

TL;DR

This study shows that methenamine hippurate is effective in preventing recurring urinary tract infections in various patient groups, offering a non-antibiotic alternative.

Contribution

The study provides evidence for using methenamine hippurate in patients with urinary tract abnormalities and catheter users.

Findings

66.7% of patients showed improvement after 12 weeks of methenamine hippurate treatment.

About half of the improved patients experienced complete resolution of UTIs.

No significant differences in outcomes were found based on urinary tract abnormalities or catheter use.

Abstract

Introduction: Recurrent urinary tract infections (rUTIs) represent a significant clinical challenge, traditionally managed with long-term antibiotic prophylaxis. However, growing concerns regarding antimicrobial resistance have necessitated the exploration of alternative treatment modalities. Methenamine hippurate (MH), a urinary antiseptic with a unique mechanism of action, has emerged as a promising non-antibiotic option for rUTI prevention.

Objective: This study aims to examine the effectiveness of MH in the prophylaxis of rUTI, with a specific focus on patients with structural or functional abnormalities of the urinary tract and those requiring catheterization to empty their bladder.

Methods: A retrospective observational study was conducted on the first 150 patients prescribed MH in a University Hospital at a Local Health Board in South Wales from April 2020 to July 2022. Patient demographics, radiological findings, functional urological status, catheter use, and treatment outcomes were analyzed. Chi-square statistical tests were used to assess associations between categorical variables and treatment outcomes.

Results: The cohort comprised 132 females (88%) with a median age of 60 years. After 12 weeks of treatment, 100 (66.7%) of patients showed improvement, with about half of these (n = 46) experiencing complete resolution of UTIs and a further third (n = 35) reporting reduced frequency or severity at six months follow-up. No statistically significant difference in long-term outcomes was observed based on radiological findings (χ2 = 0.138, df = 2, p = 0.933). Similarly, there was no significant association between functional urological status and treatment outcome (χ2 = 4.763, df = 2, p = 0.092), nor between catheter use and outcome (χ2 = 4.226, df = 2, p = 0.121)

Conclusions: MH demonstrates effectiveness for long-term management of rUTIs across diverse patient populations, including those with structural or functional urinary tract abnormalities and catheter users. These findings support the broader application of MH as a viable alternative to antibiotic prophylaxis, potentially reducing antimicrobial resistance while maintaining clinical efficacy.

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