Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Methenamine (also known as hexamethylenetetramine or hexamine) is an antimicrobial agent used in the prevention (not acute treatment) of urinary tract infections (UTIs), including bladder infections (cystitis). Its use is scientifically validated but with moderate-strength evidence. Methenamine is not a traditional antibiotic. Instead, it acts as a urinary antiseptic: when it is excreted in the urine, and if the urine is sufficiently acidic (pH < 6), methenamine hydrolyzes to release formaldehyde, which has broad-spectrum bactericidal activity. This mechanism is unique among UTI prevention strategies.

Multiple randomized controlled trials and systematic reviews have found that methenamine hippurate can reduce the recurrence of UTIs in certain populations, especially women with recurrent lower urinary tract infections. For example, a 2012 Cochrane review concluded that methenamine may be effective in preventing UTIs when used in individuals without urinary tract abnormalities. However, the evidence is less robust compared to standard antibiotic prophylaxis, and methenamine is not suitable for treating active, symptomatic infections.

Because methenamine requires acidic urine to be effective, it is often used alongside urinary acidifiers. It is generally well-tolerated and does not promote antibiotic resistance, making it an appealing option for long-term prophylaxis in selected patients. In summary, methenamine’s use in the prevention (not acute treatment) of bladder infections is supported by scientific evidence, but the overall strength of the evidence is moderate.

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