Volume 44, Issue 2 p. 197-206
REVIEW OF THERAPEUTICS

Methenamine for urinary tract infection prophylaxis: A systematic review

Jian Mei Li

Jian Mei Li

Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, New York, USA

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Leon E. Cosler

Corresponding Author

Leon E. Cosler

Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, New York, USA

Correspondence

Wesley D. Kufel, Binghamton University School of Pharmacy and Pharmaceutical Sciences, PO Box 6000, Binghamton, NY 13790, USA and Division of Infectious Diseases, State University of New York Upstate Medical University, Clinical Pharmacy Specialist, Infectious Diseases, State University of New York Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA.

Email: [email protected] and [email protected]

Leon E. Cosler, Binghamton University School of Pharmacy and Pharmaceutical Sciences, PO Box 6000, Binghamton, NY 13790, USA.

Email: [email protected]

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Elizabeth P. Harausz

Elizabeth P. Harausz

State University of New York Upstate Medical University, Syracuse, New York, USA

State University of New York Upstate University Hospital, Syracuse, New York, USA

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Courtney E. Myers

Courtney E. Myers

State University of New York Upstate Medical University, Syracuse, New York, USA

State University of New York Upstate University Hospital, Syracuse, New York, USA

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Wesley D. Kufel

Corresponding Author

Wesley D. Kufel

Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, New York, USA

State University of New York Upstate Medical University, Syracuse, New York, USA

State University of New York Upstate University Hospital, Syracuse, New York, USA

Correspondence

Wesley D. Kufel, Binghamton University School of Pharmacy and Pharmaceutical Sciences, PO Box 6000, Binghamton, NY 13790, USA and Division of Infectious Diseases, State University of New York Upstate Medical University, Clinical Pharmacy Specialist, Infectious Diseases, State University of New York Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA.

Email: [email protected] and [email protected]

Leon E. Cosler, Binghamton University School of Pharmacy and Pharmaceutical Sciences, PO Box 6000, Binghamton, NY 13790, USA.

Email: [email protected]

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First published: 20 November 2023

Abstract

Urinary tract infections (UTIs) commonly affect many patient populations. Recurrent UTIs (rUTIs) can be particularly problematic and lead to potential hospitalizations, multiple antibiotic courses, and have a potential negative impact on quality of life. To prevent UTIs, antibiotics are frequently used for prophylaxis; however, antibiotic prophylaxis has notable untoward consequences including but not limited to potential adverse effects and development of antibiotic resistance. Methenamine, an antiseptic agent initially available in 1967, has re-emerged as a potential option for UTI prophylaxis in various populations, including older adults and renal transplant recipients. The objective of this systematic review was to evaluate the clinical effectiveness and safety of methenamine for UTI prophylaxis. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance was performed. A PubMed, Embase, and Cochrane library search was conducted to identify relevant English-language studies evaluating methenamine for UTI prophylaxis including randomized controlled trials, case–control studies, and meta-analyses through June 2023. Articles were excluded if the studies did not primarily describe or evaluate methenamine for UTI prophylaxis, were commentaries/viewpoints articles, point prevalence studies, review articles, studies that evaluated methenamine used with another agent, and any duplicate publications from searched databases. A total of 11 articles were identified for inclusion. This systematic review suggests methenamine generally appears to be an effective and well-tolerated antibiotic-sparing option for UTI prophylaxis. Furthermore, the pharmacology, dosage and formulation, warnings, precautions, and safety considerations of methenamine that provide potential clinical considerations regarding its use for UTI prophylaxis are described. Further studies are needed to evaluate the clinical utility of methenamine for UTI prophylaxis.

CONFLICT OF INTEREST STATEMENT

Wesley D. Kufel has received research grants from Merck & Co. and Melinta Therapeutics and served on the advisory board for Theratechnologies, Inc. All other authors declare no conflicts of interest.