Thousands of people suffering from agonizing and recurrent bladder infections miss out on simple antiseptic treatments that kill bacteria in their urine.
The methenamine hippurate tablet bypasses the growing problems with traditional antibiotic treatments, which can damage the liver and kidneys or even become useless to antibiotic-resistant bacteria.
Also known as Hiprex, studies show that it can be just as effective when used to treat persistent infections as well as antibiotics. However, experts warn that too few patients benefit from it due to outdated prescribing guidelines and that many doctors may not even know it exists as an alternative.
Every year, more than a million Britons, 80 percent of whom are women, develop a bladder or urinary tract infection (UTI). Symptoms include burning pain when urinating, frequent urination, and a feeling of need to go to the toilet, even when the bladder is empty.
Older people are more at risk because the bladder works less with age and may not be completely emptied when they go to the toilet, so bacteria stays in the urinary tract.
Thousands of people suffering from agonizing and recurrent bladder infections miss out on simple antiseptic treatments that kill bacteria in their urine. The methenamine hippurate tablet avoids the growing problems with traditional antibiotic treatments, which can damage the liver and kidneys or even become useless to antibiotic-resistant bacteria.
Postmenopausal women are also more susceptible because the female sex hormone estrogen helps maintain the tissues of the lower urinary tract and when its levels fall, they become more vulnerable to infections.
One in ten women over the age of 65 and almost three in ten women over the age of 85 will have had a UTI in the last year. In older patients, they can cause a dementia-like condition called delirium, and there is also a risk of sepsis, leading to about 10,000 deaths a year.
For most, a short course of antibiotics clears the infection within days, but about 1.6 million people in the UK suffer from chronic urinary tract infections – classified as three or more infections a year.
The first-line treatment for these patients is to constantly take low-dose antibiotics, but about one-fifth experience side effects that can damage the liver and kidneys. Antibiotics are also becoming less effective as bacteria become resistant to drugs.
“Hiprex changed my life,” said Helen Rawnsley (above), 27, of Birmingham. Her medication was prescribed in October 2020 by a private urologist when, after three months of suffering from re-urinary tract infections, antibiotics stopped working
Hiprex offers an alternative for these patients. The drug is broken down by the body, releasing ammonia and formaldehyde, which inhibit bacterial growth – and experts believe that the pathogens that cause UTIs are unable to become resistant to them.
Reports from women suffering from chronic urinary tract infections show that the drug is very effective.
“Hiprex changed my life,” said Helen Rawnsley, 27, of Birmingham. Her medication was prescribed in October 2020 by a private urologist, when after three months of suffering from repeated urinary tract infections, the antibiotics stopped working.
“It was hell,” she says. “I remember breaking down and thinking, ‘I can’t live like this.'” Her last severe attack was in June 2021. She has been taking two Hiprex tablets every day since.
However, not all women have access to the drug as quickly as she does. This newspaper has heard the stories of many women who are either unable to get a prescription for Hiprex or cannot get their pharmacist to sign a prescription, even when provided by a urologist consultant.
Dr Kat Anderson, a women’s health expert who runs a clinic in London that specializes in recurrent urinary tract infections, reiterated a statement made by a number of experts contacted by The Mail on Sunday that it is common for GPs to never even have not heard of methenamine.
She added: “Many doctors, general practitioners and pharmacists are uncomfortable prescribing methenamine hippurate due to a lack of knowledge about how it works.
What is the difference … between efficiency and effectiveness?
The terms are often used interchangeably. However, in a medical context they have very different meanings.
Generally speaking, efficacy is related to how well drugs or other interventions perform in clinical trials.
For example, the results of a new vaccine test may show that it is 80 percent effective – meaning that those who had a prick had a 80 percent lower risk of infection than those who did not. .
Effectiveness in medicine is about how well a treatment performs in the real world.
This is because this same new vaccine may gradually become less potent over time – as we have seen with Covid, due to a reduction in protective antibodies and the mutating virus. Then it can be considered that it is, say, only 30 percent effective.
“Since the 1950s, antibiotics have been seen as something of a panacea, and other treatments have been pushed into the background. But now we know that antibiotics alone are not enough to treat many chronic urinary tract infections.
Guidelines set by the National Institutes of Health and Care (NICE) state that methenamine hippurate is “less effective” than antibiotics in treating recurrent UTIs. However, this is based on an outdated study from 2016.
A 2019 review suggests that it is effective, especially in middle-aged and older women, while another study published earlier this year concluded that, on average, women on methenamine hippurate had no more than one additional UTI per year. than those of antibiotics.
Professor Chris Harding, a consultant urologist at the Newcastle Hospitals NHS Trust who led the study, said he was optimistic that the results could encourage a change in prescribing guidelines.
The mother of two, Lisa Walton, 50, of Fleet, Hampshire, has spent thousands on methenamine privately in the past five years as her NHS doctor refuses to prescribe it.
Before that, Lisa tried several courses of antibiotics, visited a series of doctors and even underwent surgery to dilate her urethra – the narrow tube through which urine leaves the body – to prevent the capture of bacteria.
She said methenamine was crucial to her recovery, adding: “I am grateful to be able to afford it, but it is absolutely important that more people have access to it.”
Some general practitioners have refused to prescribe methenamine for long-term use because of the potential health risks of releasing formaldehyde, a known carcinogen – something that can cause cancer.
However, Professor Harding said formaldehyde levels were too low to pose a risk, while Dr Anderson said the benefits of methenamine far outweighed the risk, adding: “Patients with chronic urinary tract infections suffer from hell. . Many would only notice improvements if they were able to obtain this drug.
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