A London-led clinical trial is recruiting women with persistent urinary symptoms to test whether a 12-week course combining treatment-dose antibiotics with methenamine hippurate is a better approach to chronic urinary tract infection (UTI) than existing preventative options. The study is under way, and it has not produced results showing that the experimental combination works.
The EAT-UP study is a Phase II randomised trial involving University College London researchers and NHS hospital teams in London, Manchester and Newcastle. Its question is whether higher treatment doses of antibiotics, taken alongside methenamine hippurate, can improve infection indicators and symptoms compared with standard care. Methenamine hippurate is a urinary antiseptic used as a preventative option.
Participants are assigned at random to one of two groups for 12 weeks. The first receives methenamine hippurate twice daily plus a treatment-dose antibiotic selected by the treating clinician: cefalexin, nitrofurantoin or trimethoprim. The comparison group receives either methenamine hippurate alone or a low-dose preventative antibiotic selected from amoxicillin, cefalexin, nitrofurantoin and trimethoprim. The clinician’s choice takes account of each participant’s medical circumstances.
The main measure of efficacy is the change in white blood cell counts in fresh urine at 12 weeks. Researchers will also assess safety and whether participants can follow the treatment plans. Further measures include symptoms and quality of life, treatment satisfaction, use of rescue medication during symptom flares, and changes in bacteria found in urine and perineal samples. Participants are scheduled for clinic assessments every four weeks, with questionnaires and blood, urine and swab samples.
Who may be able to take part
The study is aimed at adults assigned female at birth who have a female urinary tract and have had daily, persistent symptoms for at least three months. The trial record specifies symptoms involving urinary frequency, urgency or urge incontinence, alongside urinary pain such as bladder pain, urethral pain or pain while urinating. Potential participants must also meet clinical screening requirements, including a fresh urine microscopy result showing at least 20 white blood cells per microlitre and a specified kidney-function threshold. Eligibility is assessed by the research team; the broad description is not a guarantee that someone can enrol.
Recruitment is listed at University College London Hospital and the Whittington Hospital in London, as well as St Mary’s Hospital in Manchester and Freeman Hospital in Newcastle upon Tyne. The trial record says the target is 192 participants. People interested in taking part can contact the EAT-UP research team through the study’s official contact channels or ask their clinician about a referral.
Why the comparison matters
Chronic UTI is described by the study team as persistent daily symptoms, unlike recurrent infections that are separated by symptom-free periods. The trial protocol says care for chronic cases commonly follows approaches used for recurrent UTI, including low-dose preventative antibiotics or methenamine hippurate alone. It also notes that routine urine tests can fail to identify infection in some people with chronic symptoms. The study is testing a treatment strategy and a way of measuring infection; it does not establish that every persistent urinary symptom is caused by infection.
The study is funded by the Medical Research Council and sponsored by University College London. Its registry entry lists it as recruiting and ongoing, with planned completion in 2028. The current public record contains no results. That distinction is important: recruitment and a trial protocol are evidence that a question is being investigated, not evidence that the new regimen is more effective or safer than the alternatives.
Using treatment-dose antibiotics for longer periods can carry risks, which is why safety is one of the trial’s stated objectives and why treatment is clinician-selected and monitored. The registry lists possible side effects from the medicines and describes regular blood tests and safety procedures. Anyone considering participation should discuss their circumstances and potential risks directly with the research team rather than changing prescribed treatment on the basis of an ongoing study.
