The medications may also help tackle the global problem of antibiotic resistance, investigators say.
Antiseptic drugs may be used as alternatives to antibiotics to prevent recurrent urinary tract infections (UTIs) and prevent antibiotic resistance, results of a study published in The BMJ showed.
Guidelines recommend a daily low dose of antibiotics as the standard preventive treatment for recurrent UTI, but the long-term use of antibiotics has been linked to antibiotic resistance.
Methenamine hippurate can sterilize urine and stop the growth of certain bacteria. Previous studies have shown that the drug can prevent UTIs. However, the evidence has been inconclusive, and more randomized trials are needed.
Investigators from Newcastle, England, aimed to test if methenamine hippurate could effectively prevent recurrent UTIs in women as an alternative to standard antibiotic treatment.
The study included 240 women, aged 18 years and older, with recurrent UTIs requiring prophylactic treatment. On average and before the trial, the individuals experienced more than 6 UTI episodes per year.
The individuals were recruited from secondary-care centers between June 2016 and June 2018.
The women were split into 2 groups: 102 women were randomly assigned to received daily antibiotics, and 103 were randomly assigned to received daily methenamine hippurate.
They took the medication for 12 months, with 3 monthly assessments up to 18 months.
The non-inferiority margin was a difference of 1 UTI episode per year. The margin was defined after a series of patient-focus group meetings.
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, with the difference being 0.49 episodes per person year.
Notably, the difference between the 2 groups was less than the predefined threshold of 1 UTI episodes per year, which suggests that methenamine hippurate was no worse than antibiotics at preventing UTIs.
Methenamine hippurate was also associated with reduced antibiotic consumption and similar levels of adverse events and treatment satisfaction compared with daily antibiotics.
And results were similar after further analyses, such as excluding days taking antibiotics for UTI, adding weight to the findings.
Additionally, investigators said that the data regarding long-term safety of methenamine hippurate are scarce, and they acknowledged the trial limitations, including lack of blinding and differences in antibiotics prescribed, which could have affected the trial results.
Furthermore, they said that 4 individuals taking methenamine hippurate were admitted to the hospital for a UTI, and 6 individuals given methenamine hippurate reported fevers during a UTI episode.
They added that the trial was well-designed to accurately represent the broad range of individuals with recurrent UTIs.
Investigators said that they hope that the study results support change in how to prevent treatments for recurrent UTIs.
Antiseptic drug as good as antibiotics for preventing recurrent urinary tract infections. EurekAlert. News release. March 9, 2022. Accessed March 10, 2022. https://www.eurekalert.org/news-releases/945617