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To the Editor.—
Dr Lester Persky made some excellent recommendations for routine care of nursing home patients with permanent catheters (236:1168, 1976), with one possible exception. He noted that methenamine mandelate would be an acceptable antibacterial for these patients. Unfortunately, the formaldehyde product of this drug is generated over time, with at least one hour (and more likely two hours) being required to get a maximum antibacterial concentration of formaldehyde. In patients whose catheters are draining directly into collection bags, the urine does not remain in the bladder long enough for formaldehyde to be generated. Therefore, methenamines are of no value to patients with catheters.
Lowenthal G. Methenamine Mandelate for Patients With Catheters. JAMA. 1977;237(10):961. doi:10.1001/jama.1977.03270370033016