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

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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Results: We included 6 studies comprising 557 participants: 5 published and one unpublished trial record with results provided; 3 compared hippurate vs placebo or control, and 3 vs antibiotics.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.
Original languageEnglish
JournalBritish Journal of General Practice
Publication statusE-pub ahead of print - 17 Jan 2021

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