In vitro study shows methenamine yields antibacterial formaldehyde levels at pH below 5.85 in a simulated urinary tract, highlighting the necessity of urine acidification for therapy.
Using an in vitro system that simulates the dynamics of the urinary tract, we have shown that concentrations of formaldehyde >/= 25 mug/ml can be achieved in urine containing >/= 0.6 mg of methenamine per ml at pH </= 5.7 or >/= 1 mg/ml at pH </= 5.85. Exposure to this concentration of formaldehyde for 2 h produced a measurable antibacterial effect. These studies suggest that an effective bacteriostatic level of formaldehyde is likely to be achieved with currently used dosages of methenamine when the urine pH is less than 5.7 to 5.85.
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Musher et al. (1974) studied this question.
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