Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial
RCT (n=240) found use of methenamine hippurate, a urinary antiseptic, non inferior to antibiotics (ABs), with incidence of AB treated UTIs over 1-year treatment period of 1.38 and 0.89 episodes per person year respectively (absolute difference 0.49, confirming non-inferiority).
Source:
British Medical Journal
SPS commentary:
An editorial notes the researchers acknowledge most caveats and limitations of their study, such as because several antibiotics were used (trimethoprim, nitrofurantoin, or cefalexin) and subgroup analyses were uninformative, how methenamine hippurate compares with different antibiotics remains unknown. It adds that although the results need cautious interpretation, they align with others, and this new research increases the confidence with which methenamine hippurate can be offered as an option to women needing prophylaxis against recurrent UTI. It highlights that whether the non-inferiority margin (1 episode of UTI) used in this trial was of the right magnitude to capture any clinically meaningful difference between treatments will likely inspire debate. However, it agrees with the authors that decisions on preventive treatment for recurrent UTI are well suited to shared decision making, where options are presented, the benefits and harms of each option are discussed, and each patient’s values and preferences are considered before patients and clinicians decide together on the next steps.