Methenamine Hippurate for the Prevention of Recurrent Urinary Tract Infections: An Evidence-Based Review

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Ana Gabriela Fernandes Peixoto Martins
Marco Rafael Lopes da Cunha - Corresponding Author

Marco Rafael Lopes da Cunha []
ORCID iD: 0000-0003-2014-2228


INTRODUCTION: Antibiotic prophylaxis is used to prevent the recurrence of urinary tract infections (UTIs), however, the growing problematic of antibiotic resistance over the last few years has led to the search for a viable alternative to antibiotics. The main goal of this review was to evaluate the evidence available regarding the effectiveness of methenamine hippurate
as an alternative to antibiotic therapy in the prophylaxis of recurrent UTIs.
METHODS: the data sources were The Cochrane Library, MEDLINE/PubMed, DARE, TRIP Medical Database, Canadian Medical Association Practice Guidelines Infobase and National Guideline Clearinghouse. Research of meta-analyses, randomized controlled trials, observational studies and guidelines written in English or Portuguese published between January 2012 and May 2022, using the MeSH terms “methenamine” and “urinary tract infections”. The level of evidence and strength of recommendation were assessed by applying the American Family Physician’s Strength of Recommendation Taxonomy (SORT) scale.
RESULTS: Of the 106 results obtained initially, 2 randomized controlled clinical trials and 1 retrospective observational study were selected. The evidence found in these studies revealed that methenamine hippurate is comparable to antibiotic prophylaxis in preventing recurrent UTIs.
CONCLUSION: This review allows us to conclude that methenamine hippurate appears as a possible, viable and safe alternative to antibiotic prophylaxis, demonstrating its non-inferiority.

Keywords: Antibiotic Prophylaxis; Hippurates; Methenamine; Urinary Tract Infections/drug therapy

Article Details

Peixoto Martins G, Lopes da Cunha MR. Methenamine Hippurate for the Prevention of Recurrent Urinary Tract Infections: An Evidence-Based Review. Gaz Med [Internet]. 2023 Dec. 29 [cited 2024 Jul. 22];10(4):315-20. Available from: