# 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.

## Key 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.