Use of Methenamine for Urinary Tract Infection Prophylaxis: Systematic Review of Recent Evidence

Use of Methenamine for Urinary Tract Infection Prophylaxis: Systematic Review of Recent Evidence

Introduction and Hypothesis Antibiotic resistance is an unavoidable consequence of antibiotic use and growing rates of resistance are an urgent issue. Methenamine is a non-antibiotic alternative used for urinary tract infection (UTI) prophylaxis. The objective of this review is to evaluate recently...

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Bibliographic Details
Published in:International Urogynecology Journal Vol. 35; no. 3; pp. 483 - 489
Main Authors: Davidson, Spencer M., Brown, Jamie N., Nance, Clayton B., Townsend, Mary L.
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01-03-2024
Springer Nature B.V
Subjects:
Antibiotics
Disease prevention
Gynecology
Medicine
Medicine & Public Health
Review Article
Urinary tract diseases
Urinary tract infections
Urogenital system
Urology
Antibiotic-sparing agent
Recurrent urinary tract infection
Antimicrobial stewardship
Women’s health
Prophylactic antibiotic
Antibiotic resistance
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Summary:Introduction and Hypothesis Antibiotic resistance is an unavoidable consequence of antibiotic use and growing rates of resistance are an urgent issue. Methenamine is a non-antibiotic alternative used for urinary tract infection (UTI) prophylaxis. The objective of this review is to evaluate recently published literature regarding the efficacy and safety of methenamine for UTI prophylaxis. Methods PubMed, Embase, and CENTRAL databases were queried in March 2023 using the following search terms: urinary tract infection, cystitis, bacteriuria, or dysuria, and methenamine. Studies prior to 2012 were excluded from this review to focus on appraisal of the most recent evidence. Prospective and controlled retrospective trials were included for review. Results A total of seven studies (three prospective and four retrospective) met the inclusion criteria for review. Two of the 3 prospective studies demonstrated no or non-inferior differences in clinical efficacy to prevent recurrent UTIs between methenamine and antibiotic prophylaxis and the third showed decreased rates of UTI with methenamine use in patients with short-term indwelling catheters compared with cranberry alone. The retrospective studies consistently supported the efficacy and safety of methenamine for UTI prophylaxis in a variety of populations and clinical settings. Adverse effects reported with methenamine were similar to comparators and included nausea, abdominal pain, and headache. Conclusions The use of methenamine for UTI prophylaxis was shown to be effective in a variety of settings without an increased risk of adverse effects compared with prophylactic antibiotics. Larger blinded clinical trials are needed to further define the role of methenamine in UTI prophylaxis.
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ISSN:0937-3462
1433-3023
1433-3023
DOI:10.1007/s00192-024-05726-2