Thousands of people with painful and recurring bladder infections lack a simple antiseptic treatment that kills bacteria in urine.
The tablet – methenamine hippurate – avoids the increasingly common problems of traditional antibiotic treatments that can damage the liver and kidneys, or even become useless in the face of antibiotic-resistant bacteria.
Also known by the brand name Hiprex, studies show it can be just as effective when used to fight persistent infections as antibiotics. Yet experts warn that too few patients are benefiting from it, due to outdated prescribing guidelines, and many doctors may not even know it exists as an alternative.
Every year more than a million Britons, 80% of them women, develop a bladder or urinary tract infection (UTI). Symptoms include burning pain when passing urine, frequent urination, and a feeling of needing to go to the toilet even when the bladder is empty.
Older people are more at risk because the bladder functions less well with age and may not empty completely when going to the toilet, so bacteria remain in the urinary tract.
Thousands of people with painful and recurring bladder infections lack a simple antiseptic treatment that kills bacteria in urine. The tablet – methenamine hippurate – helps avoid the increasingly common problems with traditional antibiotic treatments that can damage the liver and kidneys or even become useless in the face of antibiotic-resistant bacteria.
Post-menopausal women are also more prone because estrogen, a female sex hormone, helps maintain lower urinary tract tissue, and as its levels drop, they become more susceptible to infections.
One in ten women over the age of 65 and nearly three in ten women over the age of 85 will have had a urinary tract infection in the past year. In older patients, they can cause a dementia-like illness called delirium, and there is also a risk of sepsis, which causes around 10,000 deaths a year.
For the most part, a short course of antibiotics clears up the infection within days, but up to 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 stay on low-dose antibiotics all the time, but about a fifth experience side effects that can damage the liver and kidneys. Antibiotics are also increasingly ineffective as bacteria become resistant to drugs.
“Hiprex has changed my life,” says Helen Rawnsley (above), 27, from Birmingham. She was prescribed the drug in October 2020 by a private urologist when, after suffering for three months from repeated UTIs, the antibiotics stopped working
Hiprex offers an alternative option for these patients. The drug is broken down by the body, releasing ammonia and formaldehyde which inhibit bacterial growth – and experts believe the pathogens that cause UTIs are unable to become resistant to it.
Reports from women with chronic UTIs suggest that the drug is very effective.
“Hiprex has changed my life,” says Helen Rawnsley, 27, from Birmingham. She was prescribed the drug in October 2020 by a private urologist when, after suffering for three months from repeated UTIs, the antibiotics stopped working.
“It was hell,” she says. “I remember breaking down thinking, ‘I can’t live like this. ‘ Her last episode of severe symptoms was in June 2021. Since then she has been taking two Hiprex tablets a day.
However, not all women are able to access the drug as quickly as she was able to. This journal has heard the stories of many women who cannot get a prescription for Hiprex or cannot have a prescription signed by their pharmacist, even when provided by a consultant urologist.
Dr Cat Anderson, a women’s health expert who runs a clinic in London specializing in recurrent UTIs, repeated a claim made by a number of experts contacted by The Mail on Sunday that it is common for GPs to not never even heard of methenamine.
She adds: “Many doctors, GPs and pharmacists are not comfortable prescribing methenamine hippurate due to a lack of knowledge about how it works.
What is the difference… between efficiency and efficiency?
The terms are often used synonymously. However, in a medical context, they have very different meanings.
Broadly speaking, efficacy relates to the performance of drugs or other interventions in clinical trials.
So, for example, the results of trials of a new vaccine might show it to be 80% effective – meaning those who received the vaccine had an 80% lower risk of infection than those who did not. haven’t done it.
Efficacy, in medicine, refers to the performance of a treatment in the real world.
Indeed, that same new vaccine could become progressively less potent over time – as we saw in Covid, which was due to the protective antibodies dwindling and the virus mutating. It could then be considered to be, say, only 30% efficient.
“From the 1950s, antibiotics were seen as a sort of panacea and other treatments were relegated to the background. But we now know that antibiotics alone are not enough to treat many chronic urinary tract infections.
Guidelines set by the UK medicines watchdog, the National Institute for Health and Care Excellence (NICE), state that methenamine hippurate is “less effective” than antibiotics for treating recurrent UTIs. This, however, is based on an outdated study from 2016.
A 2019 review suggested it was effective, particularly in middle-aged and older women, while another study, published earlier this year, concluded that, on average, women on hippurate methenamine had no more than one additional UTI per year than those on antibiotics.
Professor Chris Harding, a consultant urologist at Newcastle Hospitals NHS Trust who led the trial, said he was optimistic the results could encourage a change in prescribing guidelines.
Mother-of-two Lisa Walton, 50, from Fleet, Hampshire, has spent thousands of dollars on methenamine privately over the past five years because her NHS GP refuses to prescribe it.
Before that, Lisa tried several rounds of antibiotics, saw a series of doctors and even underwent surgery to widen her urethra – the narrow tube through which urine leaves the body – to prevent bacteria from getting trapped.
She says methenamine was absolutely crucial to her recovery, adding: ‘I’m grateful to be able to afford it, but it’s absolutely essential that more people have access to it.’
Some GPs have refused to prescribe methenamine for long-term use due to potential health risks from the release of formaldehyde, a known carcinogen – something that could cause cancer.
However, Professor Harding believes the formaldehyde levels are too low to pose a risk, while Dr Anderson says the benefits of taking methenamine far outweigh this risk, adding: “Patients with infections chronic urinary suffer from hell”. Many would see improvements if only they could afford this drug.