Adherence to Nonantibiotic Prophylactic Regimens in Women With Recurrent Urinary Tract Infections [ID 2683400

Abstract

INTRODUCTION: Nonantibiotic regimens such as methenamine hippurate, D-mannose, and vaginal estrogen are often recommended as first-line prevention for recurrent urinary tract infections (rUTIs). The objective of our study was to describe adherence rates in women prescribed nonantibiotic prophylaxis for rUTI and explore factors associated with adherence. METHODS: This was an IRB-approved retrospective cohort study comparing women adherent and nonadherent to prophylactic regimens. 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. The medication adherence questionnaire (MAQ) was administered to all eligible patients. Adherence was defined by a score of 0. A score greater than 1 defined nonadherence. RESULTS: Eighty-six patients met inclusion criteria and completed the MAQ with 31 in the adherent and 55 in the nonadherent group. Mean age was 64.3 (+14.8) and 66.0 years (+14.4) in the adherent and nonadherent groups, respectively (P=.48). Vaginal estrogen was the most common prescribed regimen (80.6% adherent versus 90.1% nonadherent group; P=.15) followed by methenamine hippurate (38.7% adherent versus 21.8% nonadherent group; P=.08). 77.4% of adherent patients and 72.7% of nonadherent patients met criteria for rUTI as per American Urogynecologic Society best-practice statement. No demographic or clinical factors were associated with adherence to nonantibiotic prophylactic regimens. CONCLUSION: Nonantibiotic prophylactic rUTI regimens are commonly prescribed; however, adherence remains low at 36%. There were no predictors to help determine patient compliance. Clinicians should therefore inquire about adherence prior to escalating treatment.