Adherence to Non-Antibiotic Prophylactic Regimens in Women with Recurrent Urinary Tract Infections

Sarah Ashmore; Julia Geynisman-Tan; Eseohi Ehimiaghe; Morgan Cheeks; Rebecca Arteaga; Prottusha Sarkar; Deepanjana Das

doi:10.1007/s00192-024-05928-8

Adherence to Non-Antibiotic Prophylactic Regimens in Women with Recurrent Urinary Tract Infections

Int Urogynecol J. 2024 Sep 24. doi: 10.1007/s00192-024-05928-8. Online ahead of print.

Authors

Sarah Ashmore¹, Julia Geynisman-Tan², Eseohi Ehimiaghe³, Morgan Cheeks³, Rebecca Arteaga⁴, Prottusha Sarkar⁵, Deepanjana Das⁶

Affiliations

¹ Section of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago, Chicago, IL, USA. sleilaniashmore@gmail.com.
² Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern Medicine, Chicago, IL, USA.
³ Division of Obstetrics and Gynecology, Northwestern Medicine, Chicago, IL, USA.
⁴ Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁵ Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁶ Urogynecology and Reconstructive Pelvic Surgery, OB/GYN and Women's Institute, Cleveland Clinic, Cleveland, OH, USA.

PMID: 39316113
DOI: 10.1007/s00192-024-05928-8

Abstract

Introduction and hypothesis: Non-antibiotic regimens such as methenamine hippurate, D-mannose, and vaginal estrogen are often prescribed as prevention for recurrent urinary tract infections (rUTIs). The objective of our study was to describe adherence rates in women prescribed non-antibiotic prophylaxis for rUTI and to explore factors associated with adherence.

Methods: This was an ambispective cohort study describing and comparing adherence to non-antibiotic prophylactic regimens for rUTIs. Adult women who sought care from a Urogynecology clinic at a tertiary care center for rUTIs or frequent UTIs between January 2020 and December 2021 were included if they were prescribed a non-antibiotic prophylactic regimen. The Medication Adherence Questionnaire (MAQ) was administered to all eligible patients prospectively and then their charts were reviewed retrospectively for demographic and clinical factors. A score of 0 on the MAQ defined medication adherence. Any score ≥ 1 defined medication non-adherence.

Results: A total of 90 patients met the inclusion criteria and completed the MAQ, with 33 (37%) in the adherent group and 57 (63%) in the non-adherent group. Mean age was 64.7 (± 14.7) years. Vaginal estrogen (81.1%) was the most commonly prescribed prophylactic regimen, followed by methenamine hippurate (26.7%). 73.3% of patients met criteria for rUTI at the index visit as per the American Urogynecologic Society best-practice statement. No demographic or clinical factors were associated with adherence to non-antibiotic prophylactic regimens.

Conclusions: Non-antibiotic prophylactic rUTI regimens are commonly prescribed; however, adherence remains low at 37%. There were no predictors associated with patient compliance. Clinicians should therefore inquire about adherence prior to escalating treatment.

Keywords: D-mannose; Frequent urinary tract infection; Methenamine hippurate; Non-antibiotic prophylaxis; Recurrent urinary tract infections; Vaginal estrogen.