LONG TERM BENEFITS FROM LONG TERM PROPHYLAXIS IN URINARY TRACT INFECTIONS

Methenamine h.ippurate and nitrofurantoin meet the requirements for the prophylaxis of recurrent urinary tract infectiom (urls), having minimal side-effects, and low toxicity, while covering a wide range of pathogens. A comparative trial between these two compounds was recently conducted aI the Royal Free Hospital London . 99 women of childbearing age, with a history of recurrent UTis over the previous I 2 months, were treated with either Ig methenamine hippurate every 12 hours or 50mg nitrofurantoin every I 2 hours for a period of up to I year. A normru diet and "uid intake was maintained throughout treatment. After ensuring that the initial infection had been eradicated, monthly surveillan~ was maintained during the trial and results were assessed on the basis afthe number of symptom-free days and the intervals between attacks compared with the year prior to therapy. The mean period between symptomatic attacks prior to the trial was 56 days. This was extended 3·fold by methenamine and 6.4·fold by nitrofurantoin. 42 96 ortota! patient days spent on nitrofurantoin were symptom free , compared with 17% for those on methenamine. Five breakthrough infections occurred with nitrofurantoin and 25 with methenamine. 85 % of such infections were E. ro/i . No Proreus infections occurred. Side effects were 5 times more frequent witb nitrofurantoin, with one quarter of all patients having to discontinue treatment, mainly from nausea. Drug-related dysuria was reported by 4 patients on methenamine. Follow·up was ~sible in 28 patients for an average of 14] days aner stopping prophylaxis. The incidence ofatt.acks was I in 155.4 days in patients on methenamine, and I in 46] .] days for those on nitrofurantoin, showing that the benefit of the treatment continued long after medication had OOlSed. It is recommended that a woman suffering recurrent attacks of UTis be managed by first sterilising the urine, then commencing long term prophylaxis with nitrofurantoin. In the event of side effects, methenamine hippurate should be substituted. Brumlin. W. ,,( oJ .:JournaJ ofUrotogy 126: 71 Oul (981)

OI56·2103/81/1205·()()()1 $00.50/0 C ADIS Press INPHARMA50ec 1981 7

LONG TERM BENEFITS FROM LONG TERM PROPHYLAXIS IN URINARY TRACT INFECTIONS

Methenamine h.ippurate and nitrofurantoin meet the requirements for the prophylaxis of recurrent urinary tract infectiom (urls), having minimal side-effects, and low toxicity, while covering a wide range of pathogens. A comparative trial between these two compounds was recently conducted aI the Royal Free Hospital London . 99 women of childbearing age, with a history of recurrent UTis over the previous I 2 months, were treated with either Ig methenamine hippurate every 12 hours or 50mg nitrofurantoin every I 2 hours for a period of up to I year. A normru diet and "uid intake was maintained throughout treatment. After ensuring that the initial infection had been eradicated, monthly surveillan~ was maintained during the trial and results were assessed on the basis afthe number of symptom-free days and the intervals between attacks compared with the year prior to therapy. The mean period between symptomatic attacks prior to the trial was 56 days. This was extended 3·fold by methenamine and 6.4·fold by nitrofurantoin. 42 96 ortota! patient days spent on nitrofurantoin were symptom free , compared with 17% for those on methenamine. Five breakthrough infections occurred with nitrofurantoin and 25 with methenamine. 85 % of such infections were E. ro/i . No Proreus infections occurred. Side effects were 5 times more frequent witb nitrofurantoin, with one quarter of all patients having to discontinue treatment, mainly from nausea. Drug-related dysuria was reported by 4 patients on methenamine. Follow·up was ~sible in 28 patients for an average of 14] days aner stopping prophylaxis. The incidence ofatt.acks was I in 155.4 days in patients on methenamine, and I in 46] .] days for those on nitrofurantoin, showing that the benefit of the treatment continued long after medication had OOlSed. It is recommended that a woman suffering recurrent attacks of UTis be managed by first sterilising the urine, then commencing long term prophylaxis with nitrofurantoin. In the event of side effects, methenamine hippurate should be substituted. Brumlin. W. ,,( oJ .:JournaJ ofUrotogy 126: 71 Oul (981)

OI56·2103/81/1205·()()()1 $00.50/0 C ADIS Press INPHARMA50ec 1981 7