Drug may be a non-antibiotic alternative to treat UTIs

FRIDAY, March 11, 2022 (HealthDay News) — Women plagued by frequent urinary tract infections often take daily antibiotics to ward them off. But an old antibiotic alternative could work just as well, a new clinical trial finds.

Researchers found that the drug, called methenamine, was comparable to standard, low-dose antibiotics in preventing recurrent urinary tract infections in women (UTIs). Both treatments reduced the infections to an average of about one per year.

Methenamine is a long-standing medication that works by making the urine more acidic and stopping the growth of bacteria. Studies have shown it can prevent recurrent UTIs, but it’s not widely used.

It’s such an “old” drug, many doctors don’t know about it these days, said Dr. Karyn Eilber, a urologist at Cedars-Sinai Medical Center in Los Angeles.

Eilber, who was not involved in the new study, said she is reserving daily antibiotics as a last resort to prevent recurrent UTIs, preferring methenamine instead.

One concern with everyday antibiotic use is fueling antibiotic resistance, where bacteria learn to thwart the drugs used to kill them. In addition, Eilber said, it disrupts the body’s normal bacterial balance.

dr. Chris Harding, a urological consultant surgeon at Freeman Hospital in the United Kingdom, led the trial.

He said it “adds supportive evidence for methenamine use and will be especially welcome in those women with recurrent UTI who want to avoid long-term antibiotic treatment.”

UTIs are extremely common and can affect anyone, but they are most common in women. Studies suggest that up to 80% of women will develop a UTI at some point, and about a quarter of those women will have a recurrence on a regular basis.

Some symptoms include a burning sensation while urinating and a strong, persistent urge to urinate.

The new study — published online March 9 in the BMJ — included 240 women with recurrent UTIs. In the beginning, they averaged about six UTIs a year.

Half of the women were randomly assigned to daily treatment with low-dose antibiotics, while the other half took twice-daily methenamine.

Over a year of treatment, both groups saw a significant decrease in UTI episodes. Women in the antibiotic group had an average of just under one attack per person for the year, while those taking methenamine had just over one episode per person.

That’s a small difference, Harding said, and one that, based on patient focus groups, wouldn’t be considered “clinically meaningful.”

As for side effects, a small number of women in each group reported problems such as nausea, abdominal pain and diarrhea. Six women developed a UTI with a fever, and four had to be hospitalized — all of whom were in the methenamine group.

Whether treating more UTIs with methenamine will help combat the problem of antibiotic resistance is an open question. During the one-year treatment in this study, women who received antibiotics were more likely to have bacteria that were resistant to at least one antibiotic. But that changed when their bacteria were sampled six months later: Those who took methenamine had more antibiotic-resistant insects.

Harding said the finding “must be interpreted with caution” as the trial was not primarily aimed at measuring antibiotic resistance.

“Further research in this area is definitely warranted,” he said.

For now, women should know that there are options to prevent frequent UTIs, the experts said.

“Low-dose antibiotics certainly shouldn’t be the first rule,” Eilber said.

Besides methenamine, another alternative is to take an antibiotic after sex. (Sexual activity can encourage UTI-causing bacteria to enter the urethra, the tube that releases urine from the body.)

For postmenopausal women, Eilber said, vaginal estrogen may help prevent recurrent UTIs. After menopause, the vaginal tissue changes in ways that can promote the growth of “bad” bacteria.

Experts also generally recommend some self-care steps that may help, such as drinking plenty of water, urinating before and after sex, and wiping from front to back after using the bathroom.

Many of the women in the current trial went through or past menopause. But, Harding said, his team didn’t look at the treatment’s effects based on age. The study also did not include men. So it’s not clear whether the findings apply to older adults, another group at increased risk of recurrent UTI.

The study was funded by the UK’s National Institute for Health Research.

More information

The US Office on Women’s Health has more about urinary tract infections.

SOURCES: Chris Harding, MD, Consultant Urological Surgeon, Freeman Hospital, Newcastle upon Tyne, UK; Karyn Eilber, MD, urologist, Cedars-Sinai Medical Center, Los Angeles; BMJ, March 9, 2022, online

This post Drug may be a non-antibiotic alternative to treat UTIs

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