Photo Credit: jarun011
The following is a summary of “Effectiveness of methenamine hippurate in preventing urinary tract infections: an updated systematic review, meta-analysis and trial sequential analysis of randomized controlled trials,” published in the February 2025 issue of BMC Urology by Hobaica et al.
Urinary Tract Infections (UTIs) are common worldwide, especially in women. Methenamine hippurate is a proposed preventive option for recurrent cases.
Researchers conducted a retrospective study on methenamine hippurate for preventing UTIs, showing effectiveness but requiring more RCTs for confirmation.
They conducted a systematic review across MEDLINE, Embase, Scopus, Cochrane, and Google Scholar up to March 2024 for RCTs on methenamine hippurate vs. placebo or antibiotics in adult women with recurrent UTIs. Primary outcome: symptomatic UTIs. Secondary outcomes: positive urine culture, asymptomatic bacteriuria, and adverse effects. Asymptomatic UTIs with negative cultures were excluded. Adverse effects of antibiotic resistance were not reported. Risk of bias was assessed using Cochrane Risk of Bias 2. Statistical analysis was done in RStudio.
The results showed 5 articles with 216 methenamine and 205 control patients. Symptomatic UTI rates were non-inferior (RR 1.15; 95% CI 0.96, 1.38; P = 0.41; I2 = 0%). No differences were found in positive urine cultures (RR 1.20; 95% CI 0.91, 1.57; P = 0.25; I2= 28%) or adverse effects (RR 0.98; 95% CI 0.86, 1.12; P = 0.35; I2 = 9%). Asymptomatic bacteriuria was lower in the control group (RR 1.91; 95% CI 1.29, 2.81; P = 0.0001; I2 = 0%). Trial sequential analysis did not reach futility boundaries.
Investigators found methenamine hippurate to be an effective, non-inferior, and safe option for preventing recurrent UTIs. More RCTs were needed to reach futility boundaries in trial sequential analysis.
Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-025-01708-8
