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A guideline from the American Urological Association allows for 1 year of low-dose antibiotics to suppress recurrent urinary tract infections (UTIs) despite concerns about contributing to antibiotic resistance (J Urol 2019; 202:282). The nonantibiotic urinary antiseptic methenamine hippurate (which is hydrolyzed to bactericidal formaldehyde in the distal tubule) might be a useful alternative, but its effectiveness has not been studied adequately.
In a pragmatic noninferiority trial, investigators in the U.K. randomized 240 women with recurrent symptomatic UTIs (mean, 7 episodes in the past year) to receive either daily low-dose antibiotic prophylaxis (i.e., nitrofurantoin, trimethoprim, or cefalexin, at the discretion of the patient and clin…