Intended for healthcare professionals

Clinical Review

Diagnosis and management of recurrent urinary tract infections in non-pregnant women

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3140 (Published 29 May 2013) Cite this as: BMJ 2013;346:f3140

Re: Diagnosis and management of recurrent urinary tract infections in non-pregnant women

Madam,

In their review of recurrent urinary tract infections the authors omit an important weapon in the antimicrobial arsenal, lowly hexamine (methenamine hippurate).1 With the increasing prevalence of multi-resistant organisms, especially extended spectrum beta-lactamase (ESBL) producers, oral antibiotics for prophylaxis are often lacking. In the acidic conditions of the bladder, hexamine is hydrolysed to produce formaldehyde. This is active against a wide variety of microbes and is bactericidal.2,3 It is generally well tolerated and has been used successfully for prophylaxis of urinary tract infections in those with structurally normal renal tracts.4 Resistance mechanisms are different from antibiotics and resistance is not thought to significantly alter antibiotic sensitivity.3,5 It is therefore a useful option for prophylaxis in those known to be colonised with multi-drug resistant organisms.

Jonathan Underwood
junderwood@doctors.org.uk

References:
1. Diagnosis and management of recurrent urinary tract infections in non-pregnant women. Gupta K, Trautner BW. BMJ. 2013 May 29;346:f3140. doi: 10.1136/bmj.f3140.
2. The Antimicrobial Drugs. Edited by Scholar E and Pratt M. Oxford University Press 2000.
3. Antiseptics and Disinfectants: Activity, Action, and Resistance. McDonnell G and Russell AD. Clin. Microbiol. Rev. January 1999 vol. 12 no. 1 147-179
4. Methenamine hippurate for preventing urinary tract infections. Lee BS, Bhuta T, Simpson JM, Craig JC. Cochrane Database Syst Rev. 2012 Oct 17;10:CD003265. doi: 10.1002/14651858.CD003265.pub3.
5. Introduction of biocides into clinical practice and the impact on antibiotic-resistant bacteria. Russell AD. Journal of Applied Microbiology, Volume 92, Issue Supplement s1, pages 121S–135S, May 2002

Competing interests: No competing interests

03 June 2013
Jonathan Underwood
Infectious Diseases Registrar
Imperial College Healthcare NHS Trust
St Mary's Hospital, Praed Street, Paddington, London W2 1NY.