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Danielle R Fixen - One of the best experts on this subject based on the ideXlab platform.

  • effectiveness of Methenamine for uti prevention in older adults
    Annals of Pharmacotherapy, 2020
    Co-Authors: Marina S Snellings, Sunny A Linnebur, Scott M Pearson, Jeffrey I Wallace, Joseph J Saseen, Danielle R Fixen
    Abstract:

    Background: Methenamine is a drug used for the prevention of lower urinary tract infections (UTIs). However, efficacy has not been established in older adults or patients with varying degrees of kidney function. Objective: To evaluate the effectiveness of Methenamine for the prevention of UTI in adults 60 years and older. Methods: This was a retrospective, pre-post, observational study. The study included primary care patients 60 years and older who were taking Methenamine between January 1, 2015, and September 30, 2018. The primary outcome was the time to first UTI after Methenamine initiation compared with the average time between UTIs in the 12 months prior to Methenamine initiation. Results: Of 434 patients reviewed, 150 met inclusion criteria. The average time to UTI was 3.3 months prior to Methenamine initiation compared with 5.5 months after Methenamine initiation (P = 0.0004). There were 33 patients (22%) who did not have a UTI after Methenamine initiation. Also, 14 patients (9.3%) had a calculated CrCl <30 mL/min at baseline. The average time to UTI in these patients was 3.3 months prior to Methenamine initiation compared with 12.7 months after initiation (P < 0.0001). Conclusion and Relevance: Methenamine use was associated with a longer time to UTI in older adults with varying degrees of kidney function. The effectiveness of Methenamine appeared to be similar regardless of kidney function, which is new evidence. Because of a lack of acquired resistance, Methenamine may be an effective option for UTI prophylaxis in older adults.

  • Effectiveness of Methenamine for UTI Prevention in Older Adults
    The Annals of pharmacotherapy, 2019
    Co-Authors: Marina S Snellings, Sunny A Linnebur, Scott M Pearson, Jeffrey I Wallace, Joseph J Saseen, Danielle R Fixen
    Abstract:

    Background: Methenamine is a drug used for the prevention of lower urinary tract infections (UTIs). However, efficacy has not been established in older adults or patients with varying degrees of kidney function. Objective: To evaluate the effectiveness of Methenamine for the prevention of UTI in adults 60 years and older. Methods: This was a retrospective, pre-post, observational study. The study included primary care patients 60 years and older who were taking Methenamine between January 1, 2015, and September 30, 2018. The primary outcome was the time to first UTI after Methenamine initiation compared with the average time between UTIs in the 12 months prior to Methenamine initiation. Results: Of 434 patients reviewed, 150 met inclusion criteria. The average time to UTI was 3.3 months prior to Methenamine initiation compared with 5.5 months after Methenamine initiation (P = 0.0004). There were 33 patients (22%) who did not have a UTI after Methenamine initiation. Also, 14 patients (9.3%) had a calculated CrCl

  • evaluation of Methenamine for urinary tract infection prevention in older adults a review of the evidence
    Therapeutic advances in drug safety, 2019
    Co-Authors: Amy Chwa, Sunny A Linnebur, Kevin Kavanagh, Danielle R Fixen
    Abstract:

    Urinary tract infections (UTI) commonly occur in older adults and can lead to more severe, life-threatening infections. Physiological factors that change with age are thought to contribute to the increased frequency of UTI recurrence in older adults. Unfortunately, there are limited methods to prevent UTI in older adults, and utilization of antimicrobial agents for prevention can have many negative consequences. Methenamine has been proposed as a useful drug for the prevention of UTI as it works as a urinary antiseptic, safely producing formaldehyde to prevent bacterial growth while avoiding bacterial resistance. The objective of this review is to evaluate the existing literature and discuss the use of Methenamine in older adults for prevention of UTI. A PubMed search was conducted to identify studies evaluating the effectiveness of Methenamine to prevent UTI in older adults, and 10 publications were selected based on relevant criteria. Based on the literature, Methenamine appears to be a safe and effective option to prevent UTI in older adults with recurrent UTI, genitourinary surgical procedures, and potentially long-term catheterization. Studies have not evaluated the safety of Methenamine in patients with impaired renal function or CrCl <30 ml/min. When selecting a treatment approach to preventing UTI in older adults with adequate renal function, clinicians may consider Methenamine as a viable option.

  • Evaluation of Methenamine for urinary tract infection prevention in older adults: a review of the evidence.
    Therapeutic advances in drug safety, 2019
    Co-Authors: Amy Chwa, Sunny A Linnebur, Kevin A. Kavanagh, Danielle R Fixen
    Abstract:

    Urinary tract infections (UTI) commonly occur in older adults and can lead to more severe, life-threatening infections. Physiological factors that change with age are thought to contribute to the increased frequency of UTI recurrence in older adults. Unfortunately, there are limited methods to prevent UTI in older adults, and utilization of antimicrobial agents for prevention can have many negative consequences. Methenamine has been proposed as a useful drug for the prevention of UTI as it works as a urinary antiseptic, safely producing formaldehyde to prevent bacterial growth while avoiding bacterial resistance. The objective of this review is to evaluate the existing literature and discuss the use of Methenamine in older adults for prevention of UTI. A PubMed search was conducted to identify studies evaluating the effectiveness of Methenamine to prevent UTI in older adults, and 10 publications were selected based on relevant criteria. Based on the literature, Methenamine appears to be a safe and effective option to prevent UTI in older adults with recurrent UTI, genitourinary surgical procedures, and potentially long-term catheterization. Studies have not evaluated the safety of Methenamine in patients with impaired renal function or CrCl

J C Craig - One of the best experts on this subject based on the ideXlab platform.

  • Methenamine hippurate for preventing urinary tract infections
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: T Bhuta, J M Simpson, J C Craig
    Abstract:

    Background Methenamine salts are often used as an alternative to antibiotics for the prevention of urinary tract infection (UTI). This review was first published in Issue 1, 2002 and updated in Issue 4, 2007. Objectives To assess the benefits and harms of Methenamine hippurate in preventing UTI. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles and abstracts from conference proceedings without language restriction. Manufacturers' of Methenamine salts were contacted for unpublished studies and contact was made with known investigators. Date of last search: June 2012 Selection criteria Randomised controlled trials (RCT) and quasi-RCTs of Methenamine hippurate used for the prevention of UTIs in all population groups were eligible. A comparison with a control/no treatment group was a prerequisite for selection. Data collection and analysis Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). An exploration of heterogeneity and a detailed description of results, grouped by population, was undertaken. Main results Thirteen studies (2032 participants) were included. Six studies (654 patients) reported symptomatic UTI and eight studies (796 patients) reported bacteriuria. Overall, study quality was mixed. The overall pooled estimates for the major outcome measures were not interpretable because of underlying heterogeneity. Subgroup analyses suggested that Methenamine hippurate may have some benefit in patients without renal tract abnormalities (symptomatic UTI: RR 0.24, 95% CI 0.07 to 0.89; bacteriuria: RR 0.56, 95% CI 0.37 to 0.83), but not in patients with known renal tract abnormalities (symptomatic UTI: RR 1.54, 95% CI 0.38 to 6.20; bacteriuria: RR 1.29, 95% CI 0.54 to 3.07). For short-term treatment duration (1 week or less) there was a significant reduction in symptomatic UTI in those without renal tract abnormalities (RR 0.14, 95% CI 0.05 to 0.38). The rate of adverse events was low. Authors' conclusions Methenamine hippurate may be effective for preventing UTI in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. It does not appear to work in patients with neuropathic bladder or in patients who have renal tract abnormalities. The rate of adverse events was low, but poorly described. There is a need for further large well-conducted RCTs to clarify this question, particularly for longer term use for people without neuropathic bladder.

  • The Cochrane Library - Methenamine hippurate for preventing urinary tract infections
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: T Bhuta, J M Simpson, J C Craig
    Abstract:

    Background Methenamine salts are often used as an alternative to antibiotics for the prevention of urinary tract infection (UTI). This review was first published in Issue 1, 2002 and updated in Issue 4, 2007. Objectives To assess the benefits and harms of Methenamine hippurate in preventing UTI. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles and abstracts from conference proceedings without language restriction. Manufacturers' of Methenamine salts were contacted for unpublished studies and contact was made with known investigators. Date of last search: June 2012 Selection criteria Randomised controlled trials (RCT) and quasi-RCTs of Methenamine hippurate used for the prevention of UTIs in all population groups were eligible. A comparison with a control/no treatment group was a prerequisite for selection. Data collection and analysis Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). An exploration of heterogeneity and a detailed description of results, grouped by population, was undertaken. Main results Thirteen studies (2032 participants) were included. Six studies (654 patients) reported symptomatic UTI and eight studies (796 patients) reported bacteriuria. Overall, study quality was mixed. The overall pooled estimates for the major outcome measures were not interpretable because of underlying heterogeneity. Subgroup analyses suggested that Methenamine hippurate may have some benefit in patients without renal tract abnormalities (symptomatic UTI: RR 0.24, 95% CI 0.07 to 0.89; bacteriuria: RR 0.56, 95% CI 0.37 to 0.83), but not in patients with known renal tract abnormalities (symptomatic UTI: RR 1.54, 95% CI 0.38 to 6.20; bacteriuria: RR 1.29, 95% CI 0.54 to 3.07). For short-term treatment duration (1 week or less) there was a significant reduction in symptomatic UTI in those without renal tract abnormalities (RR 0.14, 95% CI 0.05 to 0.38). The rate of adverse events was low. Authors' conclusions Methenamine hippurate may be effective for preventing UTI in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. It does not appear to work in patients with neuropathic bladder or in patients who have renal tract abnormalities. The rate of adverse events was low, but poorly described. There is a need for further large well-conducted RCTs to clarify this question, particularly for longer term use for people without neuropathic bladder.

  • Methenamine hippurate for preventing urinary tract infections.
    The Cochrane database of systematic reviews, 2007
    Co-Authors: J M Simpson, J C Craig, T Bhuta
    Abstract:

    Methenamine salts are often used as an alternative to antibiotics for the prevention of urinary tract infection (UTI). To assess the benefits and harms of Methenamine hippurate in preventing UTI. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles and abstracts from conference proceedings without language restriction. Manufacturers' of Methenamine salts were contacted for unpublished studies and contact was made with known investigators. Date of last search: September 2006 Randomised controlled trials (RCT) and quasi-RCTs of Methenamine hippurate used for the prevention of UTIs in all population groups were eligible. A comparison with a control/no treatment group was a prerequisite for selection. Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes with 95% confidence intervals (CI). An exploration of heterogeneity and a detailed description of results, grouped by population, was undertaken. Thirteen studies (2032 participants) were included. Six studies (654 patients) reported symptomatic UTI and eight studies (796 patients) reported bacteriuria. Overall, study quality was mixed. The overall pooled estimates for the major outcome measures were not interpretable because of underlying heterogeneity. Subgroup analyses suggested that Methenamine hippurate may have some benefit in patients without renal tract abnormalities (symptomatic UTI: RR 0.24, 95% CI 0.07 to 0.89; bacteriuria: RR 0.56, 95% CI 0.37 to 0.83), but not in patients with known renal tract abnormalities (symptomatic UTI: RR 1.54, 95% CI 0.38 to 6.20; bacteriuria: RR 1.29, 95% CI 0.54 to 3.07). For short-term treatment duration (1 week or less) there was a significant reduction in symptomatic UTI in those without renal tract abnormalities (RR 0.14, 95% CI 0.05 to 0.38). The rate of adverse events was low. Methenamine hippurate may be effective for preventing UTI in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. It does not appear to work in patients with neuropathic bladder or in patients who have renal tract abnormalities. The rate of adverse events was low, but poorly described. There is a need for further large well-conducted RCTs to clarify this question, particularly for longer term use for people without neuropathic bladder.

T Bhuta - One of the best experts on this subject based on the ideXlab platform.

  • Methenamine hippurate for preventing urinary tract infections
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: T Bhuta, J M Simpson, J C Craig
    Abstract:

    Background Methenamine salts are often used as an alternative to antibiotics for the prevention of urinary tract infection (UTI). This review was first published in Issue 1, 2002 and updated in Issue 4, 2007. Objectives To assess the benefits and harms of Methenamine hippurate in preventing UTI. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles and abstracts from conference proceedings without language restriction. Manufacturers' of Methenamine salts were contacted for unpublished studies and contact was made with known investigators. Date of last search: June 2012 Selection criteria Randomised controlled trials (RCT) and quasi-RCTs of Methenamine hippurate used for the prevention of UTIs in all population groups were eligible. A comparison with a control/no treatment group was a prerequisite for selection. Data collection and analysis Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). An exploration of heterogeneity and a detailed description of results, grouped by population, was undertaken. Main results Thirteen studies (2032 participants) were included. Six studies (654 patients) reported symptomatic UTI and eight studies (796 patients) reported bacteriuria. Overall, study quality was mixed. The overall pooled estimates for the major outcome measures were not interpretable because of underlying heterogeneity. Subgroup analyses suggested that Methenamine hippurate may have some benefit in patients without renal tract abnormalities (symptomatic UTI: RR 0.24, 95% CI 0.07 to 0.89; bacteriuria: RR 0.56, 95% CI 0.37 to 0.83), but not in patients with known renal tract abnormalities (symptomatic UTI: RR 1.54, 95% CI 0.38 to 6.20; bacteriuria: RR 1.29, 95% CI 0.54 to 3.07). For short-term treatment duration (1 week or less) there was a significant reduction in symptomatic UTI in those without renal tract abnormalities (RR 0.14, 95% CI 0.05 to 0.38). The rate of adverse events was low. Authors' conclusions Methenamine hippurate may be effective for preventing UTI in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. It does not appear to work in patients with neuropathic bladder or in patients who have renal tract abnormalities. The rate of adverse events was low, but poorly described. There is a need for further large well-conducted RCTs to clarify this question, particularly for longer term use for people without neuropathic bladder.

  • The Cochrane Library - Methenamine hippurate for preventing urinary tract infections
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: T Bhuta, J M Simpson, J C Craig
    Abstract:

    Background Methenamine salts are often used as an alternative to antibiotics for the prevention of urinary tract infection (UTI). This review was first published in Issue 1, 2002 and updated in Issue 4, 2007. Objectives To assess the benefits and harms of Methenamine hippurate in preventing UTI. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles and abstracts from conference proceedings without language restriction. Manufacturers' of Methenamine salts were contacted for unpublished studies and contact was made with known investigators. Date of last search: June 2012 Selection criteria Randomised controlled trials (RCT) and quasi-RCTs of Methenamine hippurate used for the prevention of UTIs in all population groups were eligible. A comparison with a control/no treatment group was a prerequisite for selection. Data collection and analysis Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). An exploration of heterogeneity and a detailed description of results, grouped by population, was undertaken. Main results Thirteen studies (2032 participants) were included. Six studies (654 patients) reported symptomatic UTI and eight studies (796 patients) reported bacteriuria. Overall, study quality was mixed. The overall pooled estimates for the major outcome measures were not interpretable because of underlying heterogeneity. Subgroup analyses suggested that Methenamine hippurate may have some benefit in patients without renal tract abnormalities (symptomatic UTI: RR 0.24, 95% CI 0.07 to 0.89; bacteriuria: RR 0.56, 95% CI 0.37 to 0.83), but not in patients with known renal tract abnormalities (symptomatic UTI: RR 1.54, 95% CI 0.38 to 6.20; bacteriuria: RR 1.29, 95% CI 0.54 to 3.07). For short-term treatment duration (1 week or less) there was a significant reduction in symptomatic UTI in those without renal tract abnormalities (RR 0.14, 95% CI 0.05 to 0.38). The rate of adverse events was low. Authors' conclusions Methenamine hippurate may be effective for preventing UTI in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. It does not appear to work in patients with neuropathic bladder or in patients who have renal tract abnormalities. The rate of adverse events was low, but poorly described. There is a need for further large well-conducted RCTs to clarify this question, particularly for longer term use for people without neuropathic bladder.

  • Methenamine hippurate for preventing urinary tract infections.
    The Cochrane database of systematic reviews, 2007
    Co-Authors: J M Simpson, J C Craig, T Bhuta
    Abstract:

    Methenamine salts are often used as an alternative to antibiotics for the prevention of urinary tract infection (UTI). To assess the benefits and harms of Methenamine hippurate in preventing UTI. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles and abstracts from conference proceedings without language restriction. Manufacturers' of Methenamine salts were contacted for unpublished studies and contact was made with known investigators. Date of last search: September 2006 Randomised controlled trials (RCT) and quasi-RCTs of Methenamine hippurate used for the prevention of UTIs in all population groups were eligible. A comparison with a control/no treatment group was a prerequisite for selection. Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes with 95% confidence intervals (CI). An exploration of heterogeneity and a detailed description of results, grouped by population, was undertaken. Thirteen studies (2032 participants) were included. Six studies (654 patients) reported symptomatic UTI and eight studies (796 patients) reported bacteriuria. Overall, study quality was mixed. The overall pooled estimates for the major outcome measures were not interpretable because of underlying heterogeneity. Subgroup analyses suggested that Methenamine hippurate may have some benefit in patients without renal tract abnormalities (symptomatic UTI: RR 0.24, 95% CI 0.07 to 0.89; bacteriuria: RR 0.56, 95% CI 0.37 to 0.83), but not in patients with known renal tract abnormalities (symptomatic UTI: RR 1.54, 95% CI 0.38 to 6.20; bacteriuria: RR 1.29, 95% CI 0.54 to 3.07). For short-term treatment duration (1 week or less) there was a significant reduction in symptomatic UTI in those without renal tract abnormalities (RR 0.14, 95% CI 0.05 to 0.38). The rate of adverse events was low. Methenamine hippurate may be effective for preventing UTI in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. It does not appear to work in patients with neuropathic bladder or in patients who have renal tract abnormalities. The rate of adverse events was low, but poorly described. There is a need for further large well-conducted RCTs to clarify this question, particularly for longer term use for people without neuropathic bladder.

Sunny A Linnebur - One of the best experts on this subject based on the ideXlab platform.

  • effectiveness of Methenamine for uti prevention in older adults
    Annals of Pharmacotherapy, 2020
    Co-Authors: Marina S Snellings, Sunny A Linnebur, Scott M Pearson, Jeffrey I Wallace, Joseph J Saseen, Danielle R Fixen
    Abstract:

    Background: Methenamine is a drug used for the prevention of lower urinary tract infections (UTIs). However, efficacy has not been established in older adults or patients with varying degrees of kidney function. Objective: To evaluate the effectiveness of Methenamine for the prevention of UTI in adults 60 years and older. Methods: This was a retrospective, pre-post, observational study. The study included primary care patients 60 years and older who were taking Methenamine between January 1, 2015, and September 30, 2018. The primary outcome was the time to first UTI after Methenamine initiation compared with the average time between UTIs in the 12 months prior to Methenamine initiation. Results: Of 434 patients reviewed, 150 met inclusion criteria. The average time to UTI was 3.3 months prior to Methenamine initiation compared with 5.5 months after Methenamine initiation (P = 0.0004). There were 33 patients (22%) who did not have a UTI after Methenamine initiation. Also, 14 patients (9.3%) had a calculated CrCl <30 mL/min at baseline. The average time to UTI in these patients was 3.3 months prior to Methenamine initiation compared with 12.7 months after initiation (P < 0.0001). Conclusion and Relevance: Methenamine use was associated with a longer time to UTI in older adults with varying degrees of kidney function. The effectiveness of Methenamine appeared to be similar regardless of kidney function, which is new evidence. Because of a lack of acquired resistance, Methenamine may be an effective option for UTI prophylaxis in older adults.

  • Effectiveness of Methenamine for UTI Prevention in Older Adults
    The Annals of pharmacotherapy, 2019
    Co-Authors: Marina S Snellings, Sunny A Linnebur, Scott M Pearson, Jeffrey I Wallace, Joseph J Saseen, Danielle R Fixen
    Abstract:

    Background: Methenamine is a drug used for the prevention of lower urinary tract infections (UTIs). However, efficacy has not been established in older adults or patients with varying degrees of kidney function. Objective: To evaluate the effectiveness of Methenamine for the prevention of UTI in adults 60 years and older. Methods: This was a retrospective, pre-post, observational study. The study included primary care patients 60 years and older who were taking Methenamine between January 1, 2015, and September 30, 2018. The primary outcome was the time to first UTI after Methenamine initiation compared with the average time between UTIs in the 12 months prior to Methenamine initiation. Results: Of 434 patients reviewed, 150 met inclusion criteria. The average time to UTI was 3.3 months prior to Methenamine initiation compared with 5.5 months after Methenamine initiation (P = 0.0004). There were 33 patients (22%) who did not have a UTI after Methenamine initiation. Also, 14 patients (9.3%) had a calculated CrCl

  • evaluation of Methenamine for urinary tract infection prevention in older adults a review of the evidence
    Therapeutic advances in drug safety, 2019
    Co-Authors: Amy Chwa, Sunny A Linnebur, Kevin Kavanagh, Danielle R Fixen
    Abstract:

    Urinary tract infections (UTI) commonly occur in older adults and can lead to more severe, life-threatening infections. Physiological factors that change with age are thought to contribute to the increased frequency of UTI recurrence in older adults. Unfortunately, there are limited methods to prevent UTI in older adults, and utilization of antimicrobial agents for prevention can have many negative consequences. Methenamine has been proposed as a useful drug for the prevention of UTI as it works as a urinary antiseptic, safely producing formaldehyde to prevent bacterial growth while avoiding bacterial resistance. The objective of this review is to evaluate the existing literature and discuss the use of Methenamine in older adults for prevention of UTI. A PubMed search was conducted to identify studies evaluating the effectiveness of Methenamine to prevent UTI in older adults, and 10 publications were selected based on relevant criteria. Based on the literature, Methenamine appears to be a safe and effective option to prevent UTI in older adults with recurrent UTI, genitourinary surgical procedures, and potentially long-term catheterization. Studies have not evaluated the safety of Methenamine in patients with impaired renal function or CrCl <30 ml/min. When selecting a treatment approach to preventing UTI in older adults with adequate renal function, clinicians may consider Methenamine as a viable option.

  • Evaluation of Methenamine for urinary tract infection prevention in older adults: a review of the evidence.
    Therapeutic advances in drug safety, 2019
    Co-Authors: Amy Chwa, Sunny A Linnebur, Kevin A. Kavanagh, Danielle R Fixen
    Abstract:

    Urinary tract infections (UTI) commonly occur in older adults and can lead to more severe, life-threatening infections. Physiological factors that change with age are thought to contribute to the increased frequency of UTI recurrence in older adults. Unfortunately, there are limited methods to prevent UTI in older adults, and utilization of antimicrobial agents for prevention can have many negative consequences. Methenamine has been proposed as a useful drug for the prevention of UTI as it works as a urinary antiseptic, safely producing formaldehyde to prevent bacterial growth while avoiding bacterial resistance. The objective of this review is to evaluate the existing literature and discuss the use of Methenamine in older adults for prevention of UTI. A PubMed search was conducted to identify studies evaluating the effectiveness of Methenamine to prevent UTI in older adults, and 10 publications were selected based on relevant criteria. Based on the literature, Methenamine appears to be a safe and effective option to prevent UTI in older adults with recurrent UTI, genitourinary surgical procedures, and potentially long-term catheterization. Studies have not evaluated the safety of Methenamine in patients with impaired renal function or CrCl

J M Simpson - One of the best experts on this subject based on the ideXlab platform.

  • Methenamine hippurate for preventing urinary tract infections
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: T Bhuta, J M Simpson, J C Craig
    Abstract:

    Background Methenamine salts are often used as an alternative to antibiotics for the prevention of urinary tract infection (UTI). This review was first published in Issue 1, 2002 and updated in Issue 4, 2007. Objectives To assess the benefits and harms of Methenamine hippurate in preventing UTI. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles and abstracts from conference proceedings without language restriction. Manufacturers' of Methenamine salts were contacted for unpublished studies and contact was made with known investigators. Date of last search: June 2012 Selection criteria Randomised controlled trials (RCT) and quasi-RCTs of Methenamine hippurate used for the prevention of UTIs in all population groups were eligible. A comparison with a control/no treatment group was a prerequisite for selection. Data collection and analysis Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). An exploration of heterogeneity and a detailed description of results, grouped by population, was undertaken. Main results Thirteen studies (2032 participants) were included. Six studies (654 patients) reported symptomatic UTI and eight studies (796 patients) reported bacteriuria. Overall, study quality was mixed. The overall pooled estimates for the major outcome measures were not interpretable because of underlying heterogeneity. Subgroup analyses suggested that Methenamine hippurate may have some benefit in patients without renal tract abnormalities (symptomatic UTI: RR 0.24, 95% CI 0.07 to 0.89; bacteriuria: RR 0.56, 95% CI 0.37 to 0.83), but not in patients with known renal tract abnormalities (symptomatic UTI: RR 1.54, 95% CI 0.38 to 6.20; bacteriuria: RR 1.29, 95% CI 0.54 to 3.07). For short-term treatment duration (1 week or less) there was a significant reduction in symptomatic UTI in those without renal tract abnormalities (RR 0.14, 95% CI 0.05 to 0.38). The rate of adverse events was low. Authors' conclusions Methenamine hippurate may be effective for preventing UTI in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. It does not appear to work in patients with neuropathic bladder or in patients who have renal tract abnormalities. The rate of adverse events was low, but poorly described. There is a need for further large well-conducted RCTs to clarify this question, particularly for longer term use for people without neuropathic bladder.

  • The Cochrane Library - Methenamine hippurate for preventing urinary tract infections
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: T Bhuta, J M Simpson, J C Craig
    Abstract:

    Background Methenamine salts are often used as an alternative to antibiotics for the prevention of urinary tract infection (UTI). This review was first published in Issue 1, 2002 and updated in Issue 4, 2007. Objectives To assess the benefits and harms of Methenamine hippurate in preventing UTI. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles and abstracts from conference proceedings without language restriction. Manufacturers' of Methenamine salts were contacted for unpublished studies and contact was made with known investigators. Date of last search: June 2012 Selection criteria Randomised controlled trials (RCT) and quasi-RCTs of Methenamine hippurate used for the prevention of UTIs in all population groups were eligible. A comparison with a control/no treatment group was a prerequisite for selection. Data collection and analysis Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). An exploration of heterogeneity and a detailed description of results, grouped by population, was undertaken. Main results Thirteen studies (2032 participants) were included. Six studies (654 patients) reported symptomatic UTI and eight studies (796 patients) reported bacteriuria. Overall, study quality was mixed. The overall pooled estimates for the major outcome measures were not interpretable because of underlying heterogeneity. Subgroup analyses suggested that Methenamine hippurate may have some benefit in patients without renal tract abnormalities (symptomatic UTI: RR 0.24, 95% CI 0.07 to 0.89; bacteriuria: RR 0.56, 95% CI 0.37 to 0.83), but not in patients with known renal tract abnormalities (symptomatic UTI: RR 1.54, 95% CI 0.38 to 6.20; bacteriuria: RR 1.29, 95% CI 0.54 to 3.07). For short-term treatment duration (1 week or less) there was a significant reduction in symptomatic UTI in those without renal tract abnormalities (RR 0.14, 95% CI 0.05 to 0.38). The rate of adverse events was low. Authors' conclusions Methenamine hippurate may be effective for preventing UTI in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. It does not appear to work in patients with neuropathic bladder or in patients who have renal tract abnormalities. The rate of adverse events was low, but poorly described. There is a need for further large well-conducted RCTs to clarify this question, particularly for longer term use for people without neuropathic bladder.

  • Methenamine hippurate for preventing urinary tract infections.
    The Cochrane database of systematic reviews, 2007
    Co-Authors: J M Simpson, J C Craig, T Bhuta
    Abstract:

    Methenamine salts are often used as an alternative to antibiotics for the prevention of urinary tract infection (UTI). To assess the benefits and harms of Methenamine hippurate in preventing UTI. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles and abstracts from conference proceedings without language restriction. Manufacturers' of Methenamine salts were contacted for unpublished studies and contact was made with known investigators. Date of last search: September 2006 Randomised controlled trials (RCT) and quasi-RCTs of Methenamine hippurate used for the prevention of UTIs in all population groups were eligible. A comparison with a control/no treatment group was a prerequisite for selection. Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes with 95% confidence intervals (CI). An exploration of heterogeneity and a detailed description of results, grouped by population, was undertaken. Thirteen studies (2032 participants) were included. Six studies (654 patients) reported symptomatic UTI and eight studies (796 patients) reported bacteriuria. Overall, study quality was mixed. The overall pooled estimates for the major outcome measures were not interpretable because of underlying heterogeneity. Subgroup analyses suggested that Methenamine hippurate may have some benefit in patients without renal tract abnormalities (symptomatic UTI: RR 0.24, 95% CI 0.07 to 0.89; bacteriuria: RR 0.56, 95% CI 0.37 to 0.83), but not in patients with known renal tract abnormalities (symptomatic UTI: RR 1.54, 95% CI 0.38 to 6.20; bacteriuria: RR 1.29, 95% CI 0.54 to 3.07). For short-term treatment duration (1 week or less) there was a significant reduction in symptomatic UTI in those without renal tract abnormalities (RR 0.14, 95% CI 0.05 to 0.38). The rate of adverse events was low. Methenamine hippurate may be effective for preventing UTI in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. It does not appear to work in patients with neuropathic bladder or in patients who have renal tract abnormalities. The rate of adverse events was low, but poorly described. There is a need for further large well-conducted RCTs to clarify this question, particularly for longer term use for people without neuropathic bladder.