Use of Methenamine for Urinary Tract Infection Prophylaxis: Systematic Review of Recent Evidence,International Urogynecology Journal

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Use of Methenamine for Urinary Tract Infection Prophylaxis: Systematic Review of Recent Evidence
International Urogynecology Journal ( IF 1.8 ) Pub Date : 2024-02-08 , DOI: 10.1007/s00192-024-05726-2
Spencer M Davidson ₁ , Jamie N Brown _{2,

3} , Clayton B Nance ₂ , Mary L Townsend _{2,

4}

Affiliation

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.

中文翻译：

使用乌洛托品预防尿路感染：对最新证据的系统回顾

引言与假设

抗生素耐药性是抗生素使用不可避免的后果，耐药率不断上升是一个紧迫的问题。乌洛托品是一种非抗生素替代品，用于预防尿路感染 (UTI)。本综述的目的是评估最近发表的关于乌洛托品预防尿路感染的有效性和安全性的文献。

方法

2023 年 3 月，使用以下搜索词对 PubMed、Embase 和 CENTRAL 数据库进行了查询：尿路感染、膀胱炎、菌尿或排尿困难和乌洛托品。 2012 年之前的研究被排除在本次审查之外，以重点评估最新证据。前瞻性和对照回顾性试验均纳入审查。

结果

共有七项研究（三项前瞻性研究和四项回顾性研究）符合审查纳入标准。 3 项前瞻性研究中的 2 项表明，乌洛托品和抗生素预防在预防复发性尿路感染方面的临床疗效没有差异或非劣效差异，第三项研究显示，与单独使用蔓越莓相比，短期留置导尿管患者使用乌洛托品可降低尿路感染发生率。回顾性研究一致支持乌洛托品在各种人群和临床环境中预防 UTI 的有效性和安全性。乌洛托品报告的不良反应与对照组相似，包括恶心、腹痛和头痛。