Adherence to nonantibiotic prophylactic regimens in women with recurrent urinary tract infections: a single institution review

Urinary tract infections (UTIs) are the most common infection among women, with 20-40% of those diagnosed having a single recurrence. Nonantibiotic regimens such as methenamine Hippurate, D-mannose, and vaginal estrogen are often recommended as first-line prevention. However, little is known about patient adherence to these regimens. The objective of our study was to describe adherence rates in women prescribed nonantibiotic prophylaxis for recurrent UTIs (rUTIs) and to explore factors associated with adherence. This was a retrospective cohort study comparing women with documented adherence to prophylactic regimens to those with documented nonadherence or unknown adherence. Adult women who sought care from a Urogynecology clinic at a tertiary care center for rUTI or frequent UTI between January 2020 and December 2021 were included if they were prescribed a nonantibiotic prophylactic regimen at the index visit. Chart review was performed to collect patient demographics, whether patients met criteria for rUTI as per AUGS best-practice statement, documentation of adherence, and clinical outcomes. Adherence was defined as documented initiation and continued while non-adherence was conservatively defined as documented initiation followed by discontinuation, never initiated or unknown. Group comparisons using student’s t-test, chi square Fisher’s exact test, and Mann Whitney tests were used as appropriate. A p value of <.05 was considered significant. 149 patients met inclusion criteria with 78 in the adherent group and 71 in the nonadherent group. Mean age for the cohort was 67 years (range 18-93) and median follow-up from index visit to last visit was 9 months (range 2-16). 72% of patients in the adherent group and 58% in the non-adherent group met criteria for rUTI (p=0.09). The most prescribed regimen was vaginal estrogen (88%) followed by methenamine (16%) and D-Mannose (3%). Documented adherence at a subsequent follow-up visit was 52%. No demographic or clinical factors were associated with adherence (age, menopausal status, insurance type, concomitant urinary incontinence, history of prior prophylactic antibiotic use, or type of prophylaxis prescribed). Patients in the adherent group were more likely to be diagnosed with a subsequent UTI sooner compared to those in the nonadherent group (adherent 3 (1-7) months versus nonadherent 7 (2-12) months, p=0.005). Despite being commonly prescribed documented adherence to nonantibiotic prophylactic rUTI regimens is low at 52%. Clinicians should consider inquiring about adherence before escalating treatment. Adherent patients may be more likely to present for care sooner to check for another UTI, but we did not find any clinical factors that could predict adherence. Factors such as cost, side effects, availability, and perceived effectiveness may impact adherence. Further investigation of these factors, using a mixed methods approach is planned.View Large Image Figure ViewerDownload Hi-res image Download (PPT)