Prevention of Recurrent Urinary Tract Infections in Girls

Abstract

Death from chronic pyelonephritis of several girls with otherwise normal urinary tracts has focused our attention on the importance of controlling bacterial infections of the kidney. At the same time, difficulties encountered in the management of kidney infections were emphasized by the stormy courses of six girls with frequently recurring pyelonephritis. Although these children had anatomically normal urinary tracts and each infection could be eradicated by appropriate therapy utilizing information gained from urine cultures and sensitivity studies, reinfection invariably followed. Prior to referral, several therapeutic approaches had been tried without achieving permanent remission, including one month of hospitalization for treatment with massive doses of antibiotic combinations. Finally, a program was instituted for the purpose of preventing recurrences.1 After the infections had been cleared by appropriate antibacterial drugs, the patient was started on methenamine mandelate and, when indicated, a urinary acidifying agent. This paper describes this prophylactic program and its effectiveness in preventing recurrences of pyelonephritis as determined by its use in 20 girls over the past five years.

Lack of Effect of Methenamine in Suppression of, or Prophylaxis Against, Chronic Urinary Infection

“…Methenamine has been widely used to treat urinary infection since the beginning of the present century. The clearest indication for its use is as a prophylactic agent in otherwise healthy girls or women who have recurring urinary infection in the absence of structural abnormalities of the urinary tract (4,5). Some benefits of prophylaxis may have been demonstrated for men as well (2).…”

Impact of pH on Activity of Trimethoprim, Fosfomycin, Amikacin, Colistin and Ertapenem in Human Urine

“…In attempts to lower urinary pH various agents have been used, for example, ascorbic acid, methionine, gluconic acid, methenamine hippurate and ammonium chloride [7,8]. The advantage of ascorbic acid as an acidifying agent is due to its high excretion in urine and, therefore, it has long been used as a household remedy in the treatment of UTIs, but despite numerous studies the mechanism of any antibacterial action of ascorbic acid still remains unclear [7].…”

Predictability of Methenamine Efficacy Based on Type of Urinary Pathogen and pH

“…Urinary acidification is often employed as adjunctive therapy to enhance the conversion of methenamine to formaldehyde. Ascorbic acid is widely used as a urinary acidifier with methenamine therapy, but conflicting results have been reported in regard to its pH‐lowering effect in normal subjects and in patients with urinary‐tract infections (8–13).…”