Nahata M C, Cummins B A, McLeod D C, Butler R
J Am Geriatr Soc. 1981 May;29(5):236-9. doi: 10.1111/j.1532-5415.1981.tb01774.x.
This study involved 27 geriatric patients with asymptomatic chronic bacteriuria; all had indwelling Foley catheters. The treatment regimens (daily oral dosage) were: methenamine mandelate (MM) granules, 4 gm; MM, 4 gm, plus ascorbic acid, 4 gm; and MM, 4 gm, plus ascorbic acid, 4 gm, plus cranberry cocktail, 1 liter--administered according to a cross-over design. Proteus vulgaris, Pseudomonas aeruginosa and E. coli were the most common urinary organisms. Proteus organisms were more often found in alkaline than in acidic urines, but the type of pathogen had no influence on urinary pH. Urinary formaldehyde concentration [HCHO] was lower in patients with Proteus infection (17.7 micrograms/ml) than in those with Pseudomonas (21.9 micrograms/ml) or E. coli infection (21.8 micrograms/ml). However, for Proteus infection, [HCHO] was higher in patients receiving MM plus ascorbic acid than in those receiving MM alone. Addition of cranberry cocktail to ascorbic acid did not enhance urinary pH, [HCHO] or methenamine efficacy. Our data suggest that in Foley catheter patients with chronic asymptomatic bacteriuria secondary to Proteus, Pseudomonas or E. coli infection, the type of urinary pathogen or the urinary pH cannot be used to predict the efficacy of methenamine therapy either with or without urinary acidifying agents.
本研究纳入了27例无症状慢性菌尿症老年患者；所有患者均留置了Foley导尿管。治疗方案（每日口服剂量）为：扁桃酸乌洛托品（MM）颗粒4克；MM 4克加抗坏血酸4克；以及MM 4克加抗坏血酸4克加蔓越莓汁1升——按照交叉设计给药。普通变形杆菌、铜绿假单胞菌和大肠杆菌是最常见的尿路细菌。变形杆菌在碱性尿液中比在酸性尿液中更常见，但病原体类型对尿液pH值没有影响。变形杆菌感染患者的尿甲醛浓度[HCHO]（17.7微克/毫升）低于铜绿假单胞菌感染患者（21.9微克/毫升）或大肠杆菌感染患者（21.8微克/毫升）。然而，对于变形杆菌感染，接受MM加抗坏血酸的患者的[HCHO]高于仅接受MM的患者。在抗坏血酸中添加蔓越莓汁并未提高尿液pH值、[HCHO]或乌洛托品的疗效。我们的数据表明，对于因变形杆菌、铜绿假单胞菌或大肠杆菌感染继发慢性无症状菌尿症的Foley导尿管患者，尿路病原体类型或尿液pH值均不能用于预测乌洛托品治疗（无论是否使用尿液酸化剂）的疗效。
