Antiseptic as Effective as Antibiotics for UTI Prevention

An antiseptic drug, methenamine hippurate, may be an effective preventative alternative to antibiotics in women with urinary tract infections (UTIs).

Researchers conducted a multicenter, randomized, non-inferiority trial that included women aged 18 years or older from 8 centers in the United Kingdom from June 2016 to June 2018.

All participants were randomly assigned to receive oral antibiotics (50 or 100 mg of nitrofurantoin, 100 mg of trimethoprim, or 250 mg of cefalexin) once daily or 1 g of oral methenamine hippurate twice daily as a prophylactic treatment for UTIs for the duration of the 12-month study period. Included in the intention-to-treat analysis following 6-months of follow-up were 205 women in the antibiotics group, and 201 women in the methenamine hippurate group.

The results indicated that the incidence of antibiotic treated UTIs was 0.89 episodes per person year (95% CI, 0.65-1.12) for the antibiotics group, and 1.38 (1.05-1.72) for the methenamine group. The absolute difference was 0.49 (90% CI, 0.15-0.84).

Most of the reported adverse reactions were mild, with 24% (n = 34 of 142) of the antibiotic group and 28% (35 of 127) of the methenamine group reporting adverse reactions.

“Non-antibiotic prophylactic treatment with methenamine hippurate might be appropriate for women with a history of recurrent episodes of urinary tract infections, informed by patient preferences and antibiotic stewardship initiatives, given the demonstration of non-inferiority to daily antibiotic prophylaxis seen in this trial,” the researchers concluded.


—Leigh Precopio



Harding C, Mossop H, Homer T, et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicenter, open label, randomized, non-inferiority trial. BMJ. 2022;376:e068229. doi:10.1136/bmj-2021-0068229