Does methenamine hippurate decrease urinary tract symptoms in community adult women: a systematic review and meta-analysis

Background: Urinary tract infections (UTIs) are often treated with antibiotics and are one of the major sources of antibiotic overuse. Aim: To systematically review randomised controlled trials (RCTs) of community adult women with a history of recurrent UTIs using methenamine hippurate (hippurate) as treatment or prophylaxis. Design and setting: A 2-week systematic review of women (>18 years) with recurrent UTIs using hippurate against placebo, no treatment, or antibiotics. Methods: We searched 3 databases, clinical trial registries and citing-cited references of included studies. Results: We included 6 studies comprising 557 participants: 5 published and one unpublished trial record with results provided; 3 compared hippurate vs placebo or control, and 3 vs antibiotics. The risk of bias was high, mostly from incomplete reporting. For the number of patients remaining asymptomatic, hippurate showed a non-significant trend of benefit vs antibiotics over 12 months (RR 0.65, 95%CI 0.4-1.07, I249%); also vs control over 6/12 months (RR 0.56, 95%CI 0.13-2.35, I293%); and a non-significant trend vs any antibiotic for abacteruria, (RR 0.80, 95%CI 0.62-1.03, I223%). Similar non-significant trends of benefits for hippurate for the number of UTI or bacteriuric episodes. Non-significant difference in the number of patients experiencing adverse events between hippurate and any comparator, with a trend towards benefit for the hippurate. Antibiotic use and resistance were not consistently reported. Conclusion: There is no sufficient evidence to be certain of benefit for hippurate. Further research is needed to test it and consider its use as an alternative for antibiotic treatment for UTI.

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Oral D mannose in the prevention and treatment of recurrent urinary tract infections: A review

Urogynaecologia ◽

10.4081/uij.2021.239 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Daniele Porru ◽

Annalisa De Silvestri ◽

Edda Buffa ◽

Catherine Klersy ◽

Barbara Gardella ◽

...

Keyword(s):

Urinary Tract ◽

Antibiotic Prophylaxis ◽

Urinary Tract Infections ◽

Resistant Bacteria ◽

Control Groups ◽

Recurrent Utis ◽

Recurrent Urinary Tract Infections ◽

Long Term Treatment ◽

Significant Difference ◽

Tract Infections

The results of several studies reveal that antibiotics may promote treatment resistance by causing alterations in the intestinal flora. The development of a gut reservoir of resistant bacteria promotes the development of UTIs through autoinfection. This review aims to address clinical reliability, efficacy and safety of long-term treatment with oral D mannose for the prevention of Recurrent Urinary Tract Infections (RUTI) in females. A comprehensive MEDLINE, Embase, Scopus and Cochrane search was performed for English language reports published before December 2018 using the term “recurrent urinary tract infections and D mannose” was carried out. We searched Medline, Embase, Scopus and the Cochrane Register of Controlled Trials from January 2010 to December 2018. Eligible studies did not include non-oral therapy, local (vaginal) treatment in women with recurrent UTIs. We identified eligible original articles. A few limitations of the review are the heterogeneity of the available studies, their different rational and aim, the assumption of D mannose for prophylaxis or treatment of recurrent UTIs. Oral D mannose performs well in the prevention of UTIs recurrences, significant improvement of urinary symptoms was observed, the disease- free time was longer in the groups of patients under prophylaxis with D mannose in comparison with control groups (no treatment, antibiotic prophylaxis, prophylaxis with Proanthocyanidin (PAC) etc. The review has limitations, as the studies are heterogeneous, the meta-analysis requires classifications that can also be arbitrary. Furthermore, single-arm studies are not included. Some of the authors found this evidence inconclusive, which results as a limitation of the study. D mannose prolonged the recurrence-free interval of recurrent UTIs, thus reducing the prolonged or cyclical use of antibiotics, improving clinical symptoms, with a significant difference between treatment and control groups (no treatment, antibiotic prophylaxis, prophylaxis with Proanthocyanidin). However, most clinical trials used an association of different substances commingled with D mannose, dosages and regimens of D mannose were different. For this reason, the evidence of the efficacy of D mannose remains low.

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Xyloglucan, Hibiscus and Propolis in the Management of Uncomplicated Lower Urinary Tract Infections: A Systematic Review and Meta-Analysis

Antibiotics ◽

10.3390/antibiotics11010014 ◽

2021 ◽

Vol 11 (1) ◽

pp. 14

Author(s):

Tommaso Cai ◽

Umberto Anceschi ◽

Irene Tamanini ◽

Serena Migno ◽

Michele Rizzo ◽

...

Keyword(s):

Systematic Review ◽

Medical Device ◽

Meta Analysis ◽

Clinical Effectiveness ◽

Adult Women ◽

End Of Treatment ◽

Significant Difference ◽

Clinically Significant ◽

Tract Infections ◽

Uncomplicated Cystitis

Background: In the era of antibiotic resistance, an antibiotic-sparing approach presents an interesting alternative treatment of uncomplicated cystitis in women. Our aim is to perform a systematic review and meta-analysis to compare the effectiveness and safety profile of a medical device containing xyloglucan, hibiscus and propolis (XHP) in women with uncomplicated cystitis. Methods: Relevant databases were searched using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary endpoint was clinical or microbiological success, defined as the complete (cure) and/or non-complete (improvement) resolution of symptoms at the end of treatment, or microbiological resolutions. Results: After screening 21 articles, three studies were included, recruiting a total of 178 patients. All three studies used placebo as comparator. A statistically significant difference was found in terms of clinical or microbiological resolution between the medical device and the comparator (3 RCTs, 178 patients, OR: 0.13; 95% CI: 0.05–0.33; p < 0.0001). No clinically significant adverse effects have been reported. Conclusion: A medical device containing xyloglucan, hibiscus and propolis is superior to comparator regimens in terms of clinical effectiveness in adult women with microbiologically confirmed or clinical suspicion of uncomplicated cystitis and is associated with a high patient compliance.

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Increased fluid intake to prevent urinary tract infections: systematic review and meta-analysis

British Journal of General Practice ◽

10.3399/bjgp20x708125 ◽

2020 ◽

Vol 70 (692) ◽

pp. e200-e207 ◽

Cited By ~ 3

Author(s):

Anna Mae Scott ◽

Justin Clark ◽

Chris Del Mar ◽

Paul Glasziou

Keyword(s):

Systematic Review ◽

At Risk ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Primary Outcome ◽

Fluid Intake ◽

Risk Of Bias ◽

Antimicrobial Use ◽

Recurrent Utis ◽

Tract Infections

BackgroundApproximately 15% of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives.AimTo assess the impact of increased fluid intake in individuals at risk for UTIs, for impact on UTI recurrence (primary outcome), antimicrobial use, and UTI symptoms (secondary outcomes).Design and settingA systematic review.MethodThe authors searched PubMed, Cochrane CENTRAL, EMBASE, two trial registries, and conducted forward and backward citation searches of included studies in January 2019. Randomised controlled trials of individuals at risk for UTIs were included; comparisons with antimicrobials were excluded. Different time-points (≤6 months and 12 months) were compared for the primary outcome. Risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analyses were undertaken where ≥3 studies reported the same outcome.ResultsEight studies were included; seven were meta-analysed. There was a statistically non-significant reduction in the number of patients with any UTI recurrence in the increased fluid intake group compared with control after 12 months (odds ratio [OR] 0.39, 95% confidence interval [CI] = 0.15 to 1.03, P = 0.06); reduction was significant at ≤6 months (OR 0.13, 95% CI = 0.07 to 0.25, P<0.001). Excluding studies with low volume of fluid (<200 ml) significantly favoured increased fluid intake (OR 0.25, 95% CI = 0.11 to 0.59, P = 0.001). Increased fluid intake reduced the overall rate of all recurrent UTIs (rate ratio [RR] 0.46, 95% CI = 0.40 to 0.54, P<0.001); there was no difference in antimicrobial use (OR 0.52, 95% CI = 0.25 to 1.07, P = 0.08). Paucity of data precluded meta-analysing symptoms.ConclusionGiven the minimal potential for harm, patients with recurrent UTIs could be advised to drink more fluids to reduce recurrent UTIs. Further research is warranted to establish the optimal volume and type of increased fluid.

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Prevention of Recurrent Urinary Tract Infections in Postmenopausal Women

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v2i1.381 ◽

2014 ◽

pp. 55-60

Author(s):

Darrell Fernando ◽

Budi I Santoso

Keyword(s):

Systematic Review ◽

Urinary Tract ◽

Postmenopausal Women ◽

Urinary Tract Infections ◽

Antimicrobial Prophylaxis ◽

Prophylaxis Group ◽

Research Article ◽

Recurrent Urinary Tract Infections ◽

Significant Difference ◽

Tract Infections

Objective: To determine the most effective and applicable methods to reduce recurrence of urinary tract infections in postmenopausal women. Method: A search was conducted on Pubmed, NEJM, BMJ, and Google. After screening and selection, six articles were considered useful; comprising of two original research articles, one systematic review, and three society guidelines. Result: Society guidelines recommended continuous antimicrobial prophylaxis, with postcoital antimicrobial prophylaxis as an alternative. The first research article found similar results in continous antimicrobial prophylaxis group and intermittent antimicrobial prophylaxis group. The second research article found no significant difference in cranberry and trimethoprim group. The systematic review revealed vaginal estrogens are effective in preventing recurrent UTI, but the type of estrogen is less clear. Oral estrogens are not effective. Conclusion: Prevention of recurrent urinary tract infections in postmenopausal women include risk factor identification, non-antimicrobial prophylaxis with cranberry and vaginal estrogen preparations, and antimicrobial prophylaxis (continuous or intermittent). Keywords: postmenopausal, prevention, recurrent urinary tract infection.

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Vitamin D Status has no Influence on the Incidence of Recurrent Urinary Tract Infections after Kidney Transplantation

BANTAO Journal ◽

10.2478/bj-2014-0022 ◽

2014 ◽

Vol 12 (2) ◽

pp. 114-118 ◽

Cited By ~ 2

Author(s):

Jean Jeanov Filipov ◽

Borelli Kirilov Zlatkov ◽

Emil Paskalev Dimitrov ◽

Dobrin A. Svinarov

Keyword(s):

Vitamin D ◽

Kidney Transplantation ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Pleiotropic Effects ◽

Kidney Transplant Recipients ◽

Recurrent Utis ◽

Recurrent Urinary Tract Infections ◽

Significant Difference ◽

Tract Infections

AbstractIntroduction.Recurrent urinary tract infections (rUTIs) after kidney transplantation (KT) are associated with significant decrease in graft survival. There is a growing body of evidence for the pleiotropic effects of vitamin D (VD), including immunomodulatory and antibacterial effect. The number of studies on VD’s pleiotropic effects in kidney transplant recipients (KTRs) however is low. The aim of our study was to assess the influence of VD on the incidence of recurrent UTIs after KT.Methods. The KTRs were tested for 25-hydroxyvitamin D (25VD) between 1.05.2012 and 30.11.2012. Patients within 12 months of transplantation, performed parathyroidectomy, concomitant intake of calcineurin inhibittors and mTOR inhibitors, advanced liver disease and VD supplementation were excluded from the study. Recurrent UTIs were defined as more than 3 episodes of active UTI within the last 12 months of testing for 25VD. Statistical analysis was carried out with SPSS version 22.0 and included descriptive statistics, Mann-Whitney U test. Determination of total 25VD was performed by a validated LC-MS/MS method.Results.A total of 275 patients met the above-mentioned criteria (males 182, females 93). The mean 25VD in patients with rUTIs (n=14) was 51.41±25.17 nmol/L, whereas in the group without rUTIs (n=261) the level was 60.35±23.29 nmol/L. After matching the two groups for seasonal factors (sampling for 25VD in July, August, September) and gender 169 patients were selected, and 11 were with rUTIs. No significant difference was detected in the 25VD level in the two groups (53.30±18.37 vs 49.08±21.04 nmol/L), p=0.342.Conclusions.Despite the higher 25VD in the KTRs without rUTIs, the difference between the two groups remained insignificant.

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Re: Nitrofurantoin vs Other Prophylactic Agents in Reducing Recurrent Urinary Tract Infections in Adult Women: A Systematic Review and Meta-Analysis

The Journal of Urology ◽

10.1016/j.juro.2017.01.026 ◽

2017 ◽

Vol 197 (5) ◽

pp. 1277-1278

Author(s):

Tomas L. Griebling

Keyword(s):

Systematic Review ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Meta Analysis ◽

Adult Women ◽

Recurrent Urinary Tract Infections ◽

Tract Infections

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Nitrofurantoin vs other prophylactic agents in reducing recurrent urinary tract infections in adult women: a systematic review and meta-analysis

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2016.07.040 ◽

2016 ◽

Vol 215 (5) ◽

pp. 548-560 ◽

Cited By ~ 15

Author(s):

Jameca Renee Price ◽

Larissa A. Guran ◽

W. Thomas Gregory ◽

Marian S. McDonagh

Keyword(s):

Systematic Review ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Meta Analysis ◽

Adult Women ◽

Recurrent Urinary Tract Infections ◽

Tract Infections

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Single-Dose Fosfomycin Trometamol Versus Other Antimicrobial Regimens For Treatment Of Uncomplicated Lower Urinary Tract Infection: A Systematic Review And Meta-Analysis

The Open Microbiology Journal ◽

10.2174/1874285801913010193 ◽

2019 ◽

Vol 13 (1) ◽

pp. 193-199

Author(s):

Mubarak Alfaresi ◽

Kawther Hassan ◽

Rafi M.H. Alnjadat

Keyword(s):

Systematic Review ◽

Single Dose ◽

Urinary Tract ◽

Lower Urinary Tract ◽

Meta Analysis ◽

Significant Difference ◽

Fosfomycin Trometamol ◽

Tract Infections ◽

Alternative Antibiotic ◽

Lower Urinary

Objectives: Uncomplicated Lower Urinary Tract Infections (LUTIs) are the most common source of infection affecting women. The increasing prevalence of antimicrobial resistance to commonly prescribed antibiotics has led to the development and use of novel therapies. This current meta-analysis and systematic review evaluate the use of single-dose Fosfomycin-Trometamol (FMT) versus alternative antimicrobial regimens in the management of uncomplicated LUTI. Methods: This is a systematic review. We included observational studies and Randomized Controlled Trials (RCTs). Studies that investigated the efficacy of fosfomycin or FMT in managing uncomplicated LUTIs in any age group or gender and compared the treatment to any alternative antibiotic regimen were considered eligible. Results: After a comprehensive review of the literature, nineteen studies fulfilled the inclusion criteria. All of the eligible studies (3779 patients) investigated showed no difference between the use of single-dose fosfomycin versus alternative antibiotic regimens for LUTI treatment (OR, 1.003; 95% CI, 0.853-1.181; p = 0.967). The OR remained unchanged but became statistically significant when the random-effects model was used for sensitivity analysis (OR, 1.53; 95% CI, 1.05-2.38; p = 0.04). Conclusion: The meta-analysis revealed that there was no significant difference between single-dose FMT and the commonly prescribed antibiotic regimens in LUTI treatment outcomes such as clinical improvement and microbial eradication.

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1449. Antibiotic Choice, Duration, and Outcome in Community-Acquired Urinary Tract Infections (UTI) in Male Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1313 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S529-S529

Author(s):

Joshua C Chen ◽

Jonathan Pham ◽

Mona T Yazdi

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Outpatient Setting ◽

Sufficient Evidence ◽

Duration Of Treatment ◽

Kaiser Permanente ◽

Significant Difference ◽

Male Patients ◽

The Difference ◽

Tract Infections

Abstract Background It is common medical practice for all urinary tract infections (UTIs) in males to be diagnosed as “complicated” UTIs. Current guidelines recommend 7 to 14 days of antibiotics for complicated UTIs. Longer duration of antibiotics potentially exposes a patient to harm without sufficient evidence for benefit. This research will attempt to determine the optimal antibiotic and duration of treatment for males diagnosed with a UTI. Methods This study is a retrospective cohort study that utilized the electronic health record for Kaiser Permanente Southern California to search for male patients with a diagnosis of cystitis or UTI in the outpatient setting from 2011 to 2016. Only patients with confirmed bacteriuria >100,000 CFU/mL of a gram-negative organism were included. Exclusion criteria included Foley catheterization, intermittent self-catheterization, prostatitis and Pseudomonas infection. There were 10,662 patients in our database who fit these criteria, but only 134 patients were reviewed for preliminary analysis for this abstract. Outcomes included recurrence of UTI within 30 days of finishing treatment Results A total of 134 patients were included. Most patients were prescribed Ciprofloxacin (69%) or Cephalexin (19%). The prescription duration was >8 days for 52%, 7–8 days for 34% and <7 days for 14% of all the patients. There was a statistically significant difference in recurrence by antibiotic duration (Figure 1). The odds of recurrence were 3.9 times higher for people with <7 days prescription compared with those with > 8 days (95% CI, 1.28–11.89, P = .017) (Table 1). The odds of recurrence were 1.5 times higher for those with a prescription of 7–8 days compared with those with a prescription of > 8 days, but the difference was not statistically significant (95% CI: 0.59, 3.7, P = .38). Conclusion Male patients diagnosed with a UTI who were treated with a course of antibiotics for > 7 days were less likely to have a UTI recurrence than patients who were treated for < 7 days. However, there was no statistically significant difference between 7 to 8 days vs. >8 days of antibiotics in terms of recurrence. This study will be continued to increase study power. Determining the best treatment course will reduce healthcare cost and patient morbidity from UTI recurrences. Disclosures All authors: No reported disclosures.

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