Institute for Evidence-Based Healthcare, Bond University, Robina, Australia.
Allied Health Services, Gold Coast Hospital and Health Services, Robina, Australia.
Br J Gen Pract. 2021 Jun 24;71(708):e528-e537. doi: 10.3399/BJGP.2020.0833. Print 2021 Jul.
Urinary tract infections (UTIs) are often treated with antibiotics and are a source of antibiotic overuse.
To systematically review randomised controlled trials (RCTs) of adult women in the community with a history of recurrent UTIs and who use methenamine hippurate prophylactically.
Systematic review of women in the UK, Australia, Norway, and US (aged ≥18 years) with recurrent UTIs receiving methenamine hippurate against placebo or no treatment, and antibiotics.
The authors searched three databases, clinical trial registries, and performed forward-backward citation analysis on references of included studies.
Six studies involving 557 participants were included (447 were analysed). Of the six studies, five were published and one was an unpublished trial record with results, three compared methenamine hippurate against placebo or control, and three compared methenamine hippurate with antibiotics. For the number of patients who remained asymptomatic, methenamine hippurate showed a non-statistically significant trend of benefit versus antibiotics over 12 months (risk ratio [RR] 0.65, 95% confidence interval [CI] = 0.40 to 1.07, 49%), versus control over 6 or 12 months (RR 0.56, 95% CI = 0.13 to 2.35, 93%), and a non-statistically significant trend versus any antibiotic for abacteruria (RR 0.80, 95% CI = 0.62 to 1.03, 23%). A similar non-statistically significant trend of benefits for methenamine hippurate for the number of UTI or bacteriuric episodes was found, and a non-statistically significant difference in the number of patients experiencing adverse events between methenamine hippurate and any comparator, with a trend towards benefit for the methenamine hippurate, was identified. Antibiotic use and resistance were not consistently reported.
There is insufficient evidence to be certain of the benefits of methenamine hippurate to prevent UTI. Further research is needed to test the drug's effectiveness in preventing UTIs and as an alternative for antibiotic treatment for UTI.
尿路感染（UTIs）常采用抗生素治疗，这也是抗生素过度使用的一个来源。
系统综述有复发性尿路感染病史且使用三聚氰胺乌洛托品进行预防性治疗的社区成年女性的随机对照试验（RCTs）。
对英国、澳大利亚、挪威和美国（年龄≥18 岁）有复发性 UTI 病史的女性进行系统综述，她们接受三聚氰胺乌洛托品治疗，与安慰剂或不治疗以及抗生素进行对照。
作者检索了三个数据库、临床试验注册处，并对纳入研究的参考文献进行了前向和后向引文分析。
纳入了 6 项研究，涉及 557 名参与者（447 名进行了分析）。这 6 项研究中，有 5 项已发表，1 项为未发表的试验记录，有 3 项比较了三聚氰胺乌洛托品与安慰剂或对照，有 3 项比较了三聚氰胺乌洛托品与抗生素。在无症状患者数量方面，12 个月时，三聚氰胺乌洛托品与抗生素相比，优势无统计学意义（风险比[RR]0.65，95%置信区间[CI]为 0.40 至 1.07，95%），6 个月或 12 个月时，与对照相比，优势无统计学意义（RR 0.56，95%CI 为 0.13 至 2.35，93%），与任何抗生素相比，优势无统计学意义（RR 0.80，95%CI 为 0.62 至 1.03，95%）。对于无细菌尿，也发现了三聚氰胺乌洛托品在数量方面具有类似的优势，即无统计学意义，尿路感染或细菌尿发作次数方面也有类似的优势，但无统计学意义，而且患者不良反应数量方面，三聚氰胺乌洛托品与任何对照药物之间存在差异，无统计学意义，但有获益趋势。抗生素使用和耐药性并未得到一致报告。
目前尚无足够证据确定三聚氰胺乌洛托品预防尿路感染的益处。需要进一步研究来检验该药预防尿路感染的有效性，以及作为尿路感染抗生素治疗的替代药物。
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