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antibiotic + methenamine hippurate is a combination therapy regimen being investigated by University College London (UCL) in the Phase II EAT-UP clinical trial for the treatment of chronic urinary tract infections (UTI). This therapeutic approach involves the administration of a full treatment-dose antibiotic—specifically cefalexin, nitrofurantoin, or trimethoprim—in conjunction with the urinary antiseptic methenamine hippurate. Methenamine hippurate acts as a prodrug that is hydrolyzed into formaldehyde in the acidic environment of the distal urinary tract, providing a non-specific bactericidal effect. The addition of a treatment-dose antibiotic is intended to provide synergistic antimicrobial activity to eradicate persistent bacterial colonies and intracellular reservoirs that often characterize chronic UTIs and are frequently resistant to standard low-dose prophylactic treatments.
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