Urine infection can be treated with simple pill which doctor will not prescribe

Thousands of people suffering from painful and recurrent bladder infections are missing out on a simple antiseptic treatment that wipes out bacteria in the urine.

The tablet – methenamine hippurate – overcomes problems increasingly common with conventional antibiotic treatments that can damage the liver and kidneys or even render them useless in the face of antibiotic-resistant bacteria.

Also known by the brand name Hiprex, studies show it may be just as effective for combating persistent infections as an antibiotic. Yet experts warn that the old prescription is leaving too few patients to benefit from it, and many doctors are not even aware it exists as an option.

Every year more than one million Britons, 80 percent of whom are women, develop a bladder or urinary tract infection (UTI). Symptoms include burning pain while passing urine, frequent urination, and feeling the need to urinate even when the bladder is empty.

Older people are at greater 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 suffering from painful and recurrent bladder infections are missing out on a simple antiseptic treatment that wipes out bacteria in the urine.  The tablet - methenamine hippurate - relieves problems increasingly common with conventional antibiotic treatments that can damage the liver and kidneys or even render them useless in the face of antibiotic-resistant bacteria

Thousands of people suffering from painful and recurrent bladder infections are missing out on a simple antiseptic treatment that wipes out bacteria in the urine. The tablet – methenamine hippurate – relieves problems increasingly common with conventional antibiotic treatments that can damage the liver and kidneys or even render them useless in the face of antibiotic-resistant bacteria

Post-menopausal women are also more prone because the female sex hormone estrogen helps maintain the tissues of the lower urinary tract and as its levels drop, they are more vulnerable to infections.

One in ten women over the age of 65 and three in ten women over the age of 85 will have experienced a UTI in the past year. In older patients they can cause a dementia-like condition called delirium, and are also at risk of sepsis, which causes about 10,000 deaths per year.

For most, a short course of antibiotics clears up the infection within days, but 1.6 million people in the UK suffer from chronic UTIs – classified as having three or more infections a year.

The first-line treatment for these patients is to be permanently on low-dose antibiotics, but about a fifth experience side effects that can damage the liver and kidneys. Antibiotics are also becoming increasingly ineffective as bacteria become resistant to the drugs.

'Hiprex has changed my life,' says 27-year-old Helen Rawlsley (above) from Birmingham.  She was prescribed medication by a private urologist in October 2020 when, after suffering from recurrent UTIs for three months, the antibiotics stopped working.

‘Hiprex has changed my life,’ says 27-year-old Helen Rawlsley (above) from Birmingham. She was prescribed medication by a private urologist in October 2020 when, after suffering from recurrent UTIs for three months, the antibiotics stopped working.

Hiprex offers an alternative option for these patients. The drug is broken down by the body, releasing ammonia and formaldehyde that inhibit the growth of bacteria — and experts believe the pathogens that cause UTIs are unable to become resistant to them.

Reports from women suffering from chronic UTIs suggest that this drug is highly effective.

“Hiprex has changed my life,” says Helen Rawnsley, 27, of Birmingham. stopped working.

‘It was hell,’ she says. ‘I remember breaking down, thinking, ‘I can’t live like this.’ ‘ His last attack of severe symptoms was in June 2021. Since then she has taken two Hiprex tablets every day.

However, not all women are able to use the drug as quickly as they were. This paper has heard of many women who either cannot get a prescription for Hiprex or cannot get their pharmacist to sign a prescription, even though it is provided by a Consultant Urologist.

Dr Kat Anderson, a women’s health specialist who runs a clinic specializing in recurrent urinary infections in London, reiterated the claim made by several experts contacted by The Mail on Sunday that GPs were not required to use methenamine. It’s common to have never heard of.

She adds: ‘Many doctors, GPs and pharmacists are uncomfortable prescribing methenamine hippurate, because of the lack of information on how it works.

What is the difference… between efficacy and effectiveness?

The words are often used synonymously. However, they have very different meanings in a medical context.

Broadly speaking, efficacy is related to how well drugs or other interventions perform in clinical trials.

So, for example, test results of a new vaccine may show that it has an efficacy of 80 percent—meaning that those who had the jab had an 80 percent lower risk of infection than those who didn’t.

Effectiveness, in medicine, refers to how well a treatment performs in the real world.

That’s because the same new vaccine can gradually become less potent over time – as we saw in COVID, due to the loss of protective antibodies and the virus mutating. Then it can be considered only 30 percent effective.

‘From the 1950s onwards, antibiotics came to be seen as a panacea, and other treatments were pushed into the background. But we now know that antibiotics alone are not enough to treat many chronic urinary tract infections.’

Guidelines set by the UK’s drugs watchdog, the National Institute for Health and Care Excellence (NICE), state that methenamine hippurate is ‘less effective’ than antibiotics for treating recurrent UTIs. However, this is based on an earlier 2016 study.

A 2019 review suggested that it was effective, especially in middle-aged and older women, while another study published earlier this year concluded, on average, methenamine was a better drug than antibiotics in women on hippurate. There was not more than one additional UTI in the year.

Professor Chris Harding, a consultant urologist at Newcastle Hospitals NHS Trust, who led the trial, said he was optimistic the results could encourage changes to the set guidelines.

Lisa Walton, 50, of Fleet, Hampshire, has spent thousands privately on methenamine over the past five years because her NHS GP refused to prescribe it.

Before that, Lisa had tried several rounds of antibiotics, saw a series of doctors, and even had surgery to expand her urethra — the narrow tube through which urine leaves the body. – To prevent bacteria from getting trapped.

She says methenamine has been absolutely vital to her recovery, adding: ‘I’m grateful I can afford it, but it’s absolutely essential that more people have access to it.’

Some GPs refuse to prescribe methenamine for long-term use because of potential health risks from the release of formaldehyde, a known carcinogen – something that can cause cancer.

However, Prof Harding believes that 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 chronic UTIs has to suffer a living hell. Many will see improvement if only they can get hold of this drug.’

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