Methenamine hippurate 1g tablets

ObjectivesThis study aims to investigate the preventive effect of the antiseptic methenamine hippurate on recurrent urinary tract infections (rUTIs) in older women.MethodsTriple-blind, randomised, placebo-controlled phase IV trial with a 6-month treatment period and a 6-month follow-up. Women ≥70 years with rUTIs were recruited from general practice in Norway, Sweden, Poland, and The Netherlands. Recruitment started in December 2019, with follow-up completed at the end of June 2023. Participants were randomly assigned to methenamine hippurate 1g × 2 or placebo 1 tablet × 2 for 6 months. The primary outcome was the number of antibiotic treatments for urinary tract infections (UTIs) during the treatment period. Secondary outcomes included the number of antibiotic treatments for UTIs during the follow-up period, UTI symptom severity and episode duration. Differences in complications were measured as safety outcomes.ResultsOf 289 recruited women, 281 (97%) were included in the main analysis (140 in the methenamine hippurate group, 141 in the placebo group). During the treatment period, the methenamine hippurate group had a lower incidence of antibiotic treatments for UTIs than the placebo group, with an incidence rate ratio of 0.75 (95% CI: 0.57-1.0, p 0.049). In the follow-up period, the ratio was reversed: the methenamine hippurate group had a higher incidence of antibiotic treatments for UTIs than the placebo group, with an incidence rate ratio of 1.7 (95% CI:1.3-2.3, pDiscussionMethenamine hippurate reduces the frequency of rUTIs in older women with a point estimate of a 25% reduction, suggesting advantages over low-dose antibiotic prophylaxis because of its low potential for selection for antimicrobial resistance and mild side effects. However, discontinuation after 6-month treatment duration seems to increase the risk of UTI relapses, and physicians should be aware of this risk when initiating or discontinuing treatment.Trial registration numberClinicalTrials.gov Registry (NCT04077580); EudraCT: 2018-002235.

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ObjectivesTo describe microbiological findings during asymptomatic and symptomatic phases in older women with recurrent urinary tract infections (rUTIs), to evaluate whether antimicrobial resistance patterns of Escherichia coli among methenamine hippurate users differ from untreated controls, and to explore prescription patterns of UTI antibiotics.MethodsThis was a descriptive study alongside a multinational randomized controlled trial (ImpresU). Women aged ≥70 years with rUTIs were recruited from general practice in Norway, Sweden, Poland and the Netherlands between December 2019 and June 2022. Participants were randomized to methenamine hippurate 1 g or placebo twice daily for 6 months, followed by a 6 month follow-up period. Urinary samples were collected at baseline (asymptomatic) and during acute UTIs.ResultsWe included 281 women. A dominating uropathogen ≥105 cfu/mL was detected in 29% of the baseline urine samples. Of the 178 urinary cultures taken at acute UTIs, 163 (92%) had bacterial growth, of which a minority (10%) were reported as mixed flora. E. coli was most frequently detected both at baseline and in acute UTIs (present in any concentration in 32% versus 60% of urine samples), with highest resistance to amoxicillin (36% versus 43%), trimethoprim (16% versus 22%) and amoxicillin/clavulanate (12% versus 16%). ESBL-producing E. coli at baseline were rare (4.1%). Phylogenetic subgroup B2 was the most frequent E. coli phylotype at baseline (52%). No relevant differences in antimicrobial resistance rates were found between methenamine hippurate users and controls. Narrow-spectrum antibiotics were widely prescribed, and guideline adherence was high.ConclusionsPhysicians should be aware that 29% of older women with rUTIs in the community may have significant bacterial findings in their urine during asymptomatic phases.

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Recurrent urinary tract infection (rUTI) is a common and distressing condition disproportionately affecting females. It also accounts for a substantial proportion of antibiotic prescribing in primary care. Repeated antibiotic exposure contributes to adverse effects, disruption of the urogenital microbiome and the accelerating global threat of antimicrobial resistance. Consequently, contemporary clinical guidelines increasingly emphasise non-antibiotic prophylactic strategies as a core component of rUTI management. This narrative review synthesises contemporary evidence and guideline recommendations from the European Association of Urology (EAU), the National Institute for Health and Care Excellence (NICE), and the American Urological Association (AUA) on non-antibiotic prophylaxis for rUTI. It places particular focus on practical implementation in primary care. Behavioural and risk-factor optimisation, methenamine hippurate, topical estrogen, D-mannose, probiotics, cranberry products, immunoactive prophylaxis and intravesical therapies are reviewed. These are appraised with respect to efficacy, safety, tolerability, accessibility and quality of evidence. This review highlights key differences in guideline positioning and identifies areas of ongoing uncertainty and future research. Additionally, this review explores the central role of general practitioners in confirming diagnosis and initiating first-line non-antibiotic prophylaxis. Moreover, their role in supporting shared decision-making and managing timely specialist referral, where appropriate, is highlighted. Considerations for both men and women with rUTI are discussed. To support the translation of evidence into practice, this article includes pragmatic clinical tools, such as a shared decision-making aid, a stepwise treatment algorithm, and a structured risk-factor checklist. By integrating evidence-based non-antibiotic strategies into routine care, clinicians can reduce antibiotic exposure, improve patient outcomes, and respond proactively to the global challenge of antimicrobial resistance.

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Gastrointestinal basidiobolomycosis (GIB) is a rare invasive fungal infection of immunocompetent hosts that is endemic to Saudi Arabia and the wider Gulf region. Its presentation overlaps with inflammatory bowel disease (IBD), intestinal tuberculosis and malignancy, and many patients reach a definitive diagnosis only after surgery. We report a 39-year-old Saudi woman who presented with a 7-day history of right lower quadrant pain and non-bloody watery diarrhea. Initial bloods showed an elevated C-reactive protein of 21.5 mg/L, an erythrocyte sedimentation rate of 44 mm/hour and an absolute eosinophil count of 0.54 × 103/µL. Contrast-enhanced computed tomography (CT) demonstrated segmental wall thickening of the terminal ileum, cecum and proximal transverse colon, with a 3×5 cm intramural cecal collection. Colonoscopy revealed ulcerated congested mucosa and an ileocecal stricture; targeted biopsies showed an eosinophil-rich granulomatous inflammation with broad, sparsely septate fungal hyphae demonstrating the Splendore-Hoeppli phenomenon, positive on Grocott methenamine silver and periodic acid-Schiff stains; and tissue culture grew Basidiobolus spp. Interventional radiology and surgical drainage were considered but were technically not feasible because of the intramural location, so the patient was managed medically with oral itraconazole at 200 mg every 8 hours for 3 days followed by 200 mg once daily, with monthly liver enzyme monitoring. Surgery was avoided. A repeat CT scan at 2 months showed near complete resolution of wall thickening, and follow-up colonoscopy at 5 months was normal. The patient self-discontinued itraconazole at 9 months because of symptom resolution and remained asymptomatic at follow-up 2 months later. Clinicians working in endemic regions should consider GIB in any patient with an ileocecal mass or abscess, eosinophilia and an IBD-like presentation, because early biopsy with fungal stains and prompt azole therapy can avert surgery.

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We report a case of juvenile paracoccidioidomycosis in a previously healthy patient and aim to raise awareness of its severe and atypical clinical manifestations. A 16-year-old male student, employed in automotive cleaning services, originally from Pará and residing in Embu das Artes, São Paulo, presented with progressive lymphadenopathy, jaundice, and signs of acute liver failure. He was admitted to a tertiary hospital, where imaging and histopathological analyses confirmed the diagnosis of paracoccidioidomycosis by identifying Paracoccidioides spp. on lymph node biopsy using periodic acid-Schiff and Grocott's methenamine silver stains. The patient subsequently developed hepatic dysfunction, ascites, encephalopathy, and acute kidney injury. He progressed to sepsis due to Acinetobacter baumannii infection and required intensive care support, including broad-spectrum antimicrobial treatment, antifungal therapy, vasopressor support, and renal replacement therapy. Despite aggressive management, the patient died from septic shock and multiorgan failure. Histopathological examination confirmed disseminated fungal infection. This case highlights a rare and severe hepatic presentation of juvenile paracoccidioidomycosis and reinforces the importance of including systemic mycoses in the differential diagnosis of acute febrile illnesses accompanied by hepatosplenomegaly and lymphadenopathy in endemic regions.

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