From the Guidelines
Alternative therapies for urinary tract infection (UTI) treatment include vaginal estrogen replacement, immunoactive prophylaxis, and methenamine hippurate, as recommended by the most recent guidelines. For recurrent UTIs, preventive strategies include:
- Vaginal estrogen replacement in postmenopausal women 1
- Immunoactive prophylaxis to reduce recurrent UTI in all age groups 1
- Methenamine hippurate to reduce recurrent UTI episodes in women without abnormalities of the urinary tract 1
- Continuous or postcoital antimicrobial prophylaxis to prevent recurrent UTI when non-antimicrobial interventions have failed 1 Other options, such as cranberry products and D-mannose, have weaker evidence supporting their use and should be considered on a case-by-case basis, with patients informed of the low quality and contradictory findings regarding their effectiveness 1. It is essential to consult a healthcare provider before starting any new treatment regimen, as they can tailor recommendations based on your specific situation and medical history. Key considerations in choosing an alternative therapy include the patient's age, menopausal status, and presence of underlying urinary tract abnormalities, as well as their individual preferences and medical history. In general, the choice of alternative therapy should prioritize the strongest available evidence and be guided by the most recent clinical guidelines, such as those published in the European Urology journal in 2024 1.
From the FDA Drug Label
Methenamine hippurate tablets is indicated for prophylactic or suppressive treatment of frequently recurring urinary tract infections when long-term therapy is considered necessary. Phenazopyridine HCl is indicated for the symptomatic relief of pain, burning, urgency, frequency, and other discomforts arising from irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, endoscopic procedures, or the passage of sounds or catheters
Alternative therapies for urinary tract infection (UTI) treatment include:
- Methenamine hippurate for prophylactic or suppressive treatment of frequently recurring UTIs 2
- Phenazopyridine for symptomatic relief of pain, burning, urgency, frequency, and other discomforts arising from irritation of the lower urinary tract mucosa caused by infection 3 Note that these therapies are not replacements for definitive treatment of the underlying infection, and antibacterial therapy should be instituted promptly to control the infection.
From the Research
Alternative Therapies for UTI Treatment
- Methenamine hippurate is a potential alternative therapy for the prevention of recurrent urinary tract infections (UTI) 4, 5, 6, 7, 8
- Studies have shown that methenamine hippurate can reduce the incidence of UTI and reinfection rates in patients with recurrent UTI 4, 5, 7, 8
- Methenamine hippurate has been compared to trimethoprim for the prevention of recurrent UTI, with similar rates of recurrence and adverse effects found between the two treatments 6
- The use of methenamine hippurate as a prophylactic agent may be beneficial in reducing the number of UTI recurrences, particularly in patients with a history of recurrent UTI 7, 8
Patient Outcomes
- Patients treated with methenamine hippurate have shown significant reductions in UTI recurrence rates, with some studies reporting a reduction of approximately two thirds in the number of reinfections 7, 8
- Methenamine hippurate has been well-tolerated, with few side effects reported, including complaints of taste in some patients 8
- No significant adverse effects, such as bacterial resistance or deterioration of renal function, have been observed with the use of methenamine hippurate for UTI prophylaxis 5, 7
Treatment Considerations
- Methenamine hippurate may be used as a long-term prophylactic agent to reduce the risk of UTI recurrence in patients with a history of recurrent UTI 5, 7, 8
- The use of methenamine hippurate as a treatment for established UTI may be limited, and antibiotics may be necessary to achieve abacteriuria in these cases 7