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Methenamine hippurate for recurrent urinary tract infections

BMJ 2022; 376 doi: (Published 09 March 2022) Cite this as: BMJ 2022;376:o533

Linked Research

Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women

  1. Tammy C Hoffmann, professor of clinical epidemiology1,
  2. Mina Bakhit, postdoctoral research fellow1,
  3. Chris Del Mar, professor of public health1
  1. 1Institute for Evidence Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
  1. Correspondence to: T Hoffmann thoffmann{at}

New trial increases confidence in this non antibiotic alternative

Over half of women have at least one urinary tract infection in their lifetime.1 Recurrence (that is, 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.2 Daily low dose antibiotics is the prophylactic intervention recommended by current guidelines.34 Women with recurrent urinary tract infection describe frustration about the condition, its management, fears about frequent antibiotic use and consequences such as adverse events and resistance, and a desire for non-antibiotic alternative research.56 Given the increasing global burden of antibiotic resistance,7 strategies that minimise unnecessary antibiotic use are paramount at both the individual and community level.

Methenamine hippurate is a urinary antiseptic and non-antibiotic alternative. Systematic reviews89 synthesising existing trials concluded that while methenamine hippurate might be effective, the evidence is inconclusive and large, well conducted randomised trials are needed. In the linked article (doi:10.1136/bmj-2021-0068229), Harding and colleagues report a large trial (n=240) of adult women presenting with recurrent, uncomplicated urinary tract infection who were randomised to receive methenamine …

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