Elderly patients with complicated recurrent UTIs due to resistant bacteria are often left with no oral antibiotic options. Costs escalate rapidly when IV antibiotics are given. Administration generally requires hospitalization with close monitoring of renal function and drug levels and the placement of a PICC or midline IV access. If there is no caregiver, then hospitalization followed by an admission to a skilled nursing facility is required.
Lee and colleagues concluded that there is a need for further studies to explore long-duration therapy with methenamine.21 No studies have addressed its use in the geriatric population for long-term use of prevention of recurrent UTIs. No studies have been done on its use for primary treatment of MDR UTIs. The benefits of this drug with a low AE profile and low cost ($60/month for 1 g bid), which has been proven to reduce the incidence and/or delay recurrence of UTIs, is well worth further examination.
Conclusion
Multiple studies over 60 years have shown methenamine hippurate to be a well-tolerated and safe medication. Little data are available about the use of this medication in the elderly in the U.S., despite its wide use in Scandinavian countries. Use of methenamine for MDR UTIs in the geriatric population has been shown to be safe and effective, as presented in these case studies. Substantial cost savings were realized with the use of methenamine in these geriatric patients by reducing hospitalizations and complications due to recurrent MDR UTIs. The use of methenamine for treating MDR UTIs and the prevention of recurrent UTIs in the geriatric population warrants further clinical use and research.
The very interesting changes noted in sensitivity of the same bacteria in subsequent UTIs in patients treated with methenamine raises questions about the action of formaldehyde in the bladder on bacterial resistance factors. Given the worldwide increase in bacterial resistance to currently available antibiotics, this is a most compelling action that demands further study.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.