New Antiseptic Treatment Could Reduce Antibiotic Use For UTIs: Study

Amid global concerns about the proliferation of antibiotic-resistant bacteria and widespread overuse of antibiotics, new research suggests antiseptic treatment for women suffering from frequent urinary tract infections may be just as effective as antibiotics, and allow doctors to avoid prescribing the drugs in may situations.

Women given antibiotics and those given an antiseptic treatment had similar rates of recurrent unitary tract infections (UTIs), according to findings published this month in the medical journal The BMJ. However, use of the antiseptic treatments may be preferable, because it does not contribute to emergence of dangerous “super-bugs” that are resistant to available antibiotics.

Researchers from the United Kingdom conducted a study involving 240 women over the age of 18, who had recurrent urinary tract infections and were treated at eight medical centers. The women were assigned either prophylactic antibiotic treatment or methenamine hippurate; a type of antiseptic treatment, and had follow-up visits every three months.

Recurrent UTI was categorized as having at least two UTIs in the past six months or three infections in the past year.

Roughly half of all adult women will have at least one UTI in their lifetime and 25% will have recurrent infections. Symptoms include burning sensation while urinating, increased frequency of urination and lower abdominal pain. The risk of UTI can be lowered by drinking plenty of water, urinating before and after sex, and wiping front to back.

The study found that methenamine hippurate treatment was as effective as treating a UTI with antibiotics, and does not contribute to rise of antibiotic-resistant infections, which lead to 35,000 deaths in the US every year.

The incidence of UTIs in the antibiotic group was 0.89 episodes per person year, and 1.38 per person year in the methenamine hippurate group. While the rate was higher in the antiseptic group, the researchers determined the difference was not statistically significant, and they pointed out that the antiseptic treatment may present benefits beyond UTI treatment. Both groups suffered about one infection per year, compared to the three or more they were previously experiencing.

Adverse reaction rates were similar in both groups. Roughly 24% of the antibiotic group reported side effects compared to 28% of the methenamine group. However, most reactions were mild.

Methenamine is an antiseptic which makes the urine more acidic and helps prevent bacterial growth in the urinary tract. Other studies have shown it may help prevent recurrent UTIs, but it hasn’t been widely studied. Other research has called for a more limited use of antibiotics and a targeted approach when treated women’s UTIs.

Taking repeated courses of antibiotics not only increases the likelihood of antibiotic resistant bacteria, but it can also harm the good gut bacteria which contributes to a healthy microbiome.

“Non-antibiotic prophylactic treatment with methenamine hippurate might be appropriate for women with a history of recurrent episodes of urinary tract infections, informed by patient preferences and antibiotic stewardship initiatives, given the demonstration of non-inferiority to daily antibiotic prophylaxis seen in this trial,” the researchers determined.

The results of the study may support a change in clinical practice in how preventive antibiotic treatments for recurrent UTIs are offered to patients and may lead to the practice of using methenamine for women who suffer from frequent infections.