Antiseptic drug is as good as antibiotic in preventing recurrent UTIs, says research
https://www.news9live.com/health/medicine/antiseptic-drug-is-as-good-as-antibiotic-in-preventing-recurrent-utis-says-research-158686
Scientists found that methenamine hippurate, sterilises urine, stopping the growth of certain bacteria.
Over half of women have at least one urinary tract infection in their lifetime.
Study demonstrates that the non-antibiotic preventive treatment for UTI is not inferior to the present guideline recommended standard.
The latest
research has found that an antiseptic drug is as good as antibiotic when it
comes to preventing recurrent urinary tract infections (UTIs) in women. The
study published in the British Medical Journal, can help find alternatives to
antibiotics that are already available in the market. Scientists at the
Newcastle Hospitals in the UK found that methenamine hippurate, sterilises
urine, stopping the growth of certain bacteria.
Another study led by Professor Tammy C Hoffmann, Clinical Epidemiology at
Institute for Evidence-Based Healthcare, Faculty of Health Sciences and
Medicine, Bond University, Gold Coast, Australia said that this drug, a urinary
antiseptic and non-antibiotic alternative, could be effective in preventing
UTIs, but the evidence is inconclusive and further randomised trials are
needed. Although self-reported, the diagnosis needed clinician confirmation.
Burden of UTI
Over half
of women have at least one urinary tract infection in their lifetime.
Recurrence (at least three repeated infections per year or two infections in
the preceding six months) occurs in about a quarter of women who have one
episode. Daily low dose antibiotics is the prophylactic intervention
recommended by current guidelines. However, women with recurrent UTI are
frustrated about the condition, its management, fears frequent antibiotic use,
and consequences.
Preventing recurrent UTIs
Given the
increasing global burden (About 150 million people suffer from UTIs each year
globally) of antibiotic resistance, strategies that minimise unnecessary
antibiotic use are paramount. The present guidelines recommend daily low dose
antibiotics as the standard preventive treatment for recurrent UTIs. Professor
Chris Harding, consultant, Urological Surgeon at Newcastle Hospitals and
honorary clinical senior lecturer at Newcastle University, led the study and
worked with colleagues to test if methenamine hippurate is an effective
alternative to standard antibiotic treatment.
Professor Harding said, "The outcomes of this trial could support a change
in practice in terms of preventive treatments for recurrent UTI and provide
patients and clinicians with a credible alternative to daily antibiotics,
giving them the confidence to pursue strategies that avoid long term antibiotic
use. We hope that the information provided by this trial might encourage
patients and clinicians to consider methenamine hippurate as a first-line
treatment for UTI prevention in women."
Participants
Between
June 23, 2016, and June 20, 2018, 240 women participants were recruited and
randomly assigned to antibiotic prophylaxis or methenamine hippurate. For those
allocated to antibiotic prophylaxis, 66 (55 per cent) received nitrofurantoin,
30 (25 per cent) trimethoprim, 24 (20 per cent) cefalexin. A total of 22 (18
per cent) participants allocated to methenamine hippurate switched to receive
antibiotic prophylaxis and seven (6 per cent) vice-versa. On average, before
trial entry, these women experienced over six UTI episodes per year.
Alternative available
Over 12
months, the incidence of antibiotic treated urinary tract infection was 0.89
and 1.38 episodes per person year in the antibiotic group and methenamine
hippurate groups, respectively (absolute difference 0.49 episodes (90 per cent
confidence interval 0.15 to 0.84). Because this study was a non-inferiority
trial with a difference between treatments less than the pre-specified
non-inferiority margin of one episode per person-year, the authors reported
that methenamine hippurate was no worse than antibiotics at preventing urinary
tract infection. Patient partnership guided the non-inferiority margin chosen,
along with the decision to use a clinical definition rather than a microbiological
definition of urinary tract infection for the primary outcome.
Treatment
On average, treatment satisfaction was high and generally comparable between treatment groups, although the antibiotic prophylaxis group reported higher scores in the convenience domain than the methenamine hippurate group.
Results
This trial has demonstrated that the non-antibiotic preventive treatment for UTI (methenamine hippurate) is not inferior to the current guideline recommended standard (daily, low dose prophylactic antibiotics). This trial adds to the evidence base for the use of methenamine hippurate for prophylactic treatment in adult women with recurrent UTI. Although the methenamine hippurate group had a 55 per cent higher rate of UTI episodes than the antibiotics group, the absolute difference was just 0.49 UTI episodes per year, which has limited clinical consequence.
"Decisions
on preventive treatment for recurrent urinary tract infection are well suited
to shared decision making between each patient and their doctor, and will
hopefully help to inform this important conversation," Professor Harding
added.