https://doi.org/10.4081/uij.2021.239

Oral D mannose in the prevention and treatment of recurrent urinary tract infections: A review

Vol. 33 No. 1 (2021)
Published: 12 July 2021
Recurrent urinary tract infections, urinary tract infections, D mannose, antibiotic prophylaxis, proantocyanidin
Abstract Views: 2495
PDF: 301
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Authors

Daniele Porru
danieleporru@tin.it
https://orcid.org/0000-0002-8502-6669
Department of Urology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Annalisa De Silvestri
Clinical Epidemiology and Biometrics Service, Scientific Directorate, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Edda Buffa
Department of Urology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Catherine Klersy
Clinical Epidemiology and Biometrics Service, Scientific Directorate. Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Barbara Gardella
Gynecology and Obstetric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Arsenio Spinillo
Gynecology and Obstetric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Hussein Jallous
https://orcid.org/0000-0002-5045-1577
Department of Urology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

The results of several studies reveal that antibiotics may promote treatment resistance by causing alterations in the intestinal flora. The development of a gut reservoir of resistant bacteria promotes the development of UTIs through autoinfection. This review aims to address clinical reliability, efficacy and safety of long-term treatment with oral D mannose for the prevention of Recurrent Urinary Tract Infections (RUTI) in females. A comprehensive MEDLINE, Embase, Scopus and Cochrane search was performed for English language reports published before December 2018 using the term “recurrent urinary tract infections and D mannose” was carried out. We searched Medline, Embase, Scopus and the Cochrane Register of Controlled Trials from January 2010 to December 2018. Eligible studies did not include non-oral therapy, local (vaginal) treatment in women with recurrent UTIs. We identified eligible original articles. A few limitations of the review are the heterogeneity of the available studies, their different rational and aim, the assumption of D mannose for prophylaxis or treatment of recurrent UTIs. Oral D mannose performs well in the prevention of UTIs recurrences, significant improvement of urinary symptoms was observed, the disease- free time was longer in the groups of patients under prophylaxis with D mannose in comparison with control groups (no treatment, antibiotic prophylaxis, prophylaxis with Proanthocyanidin (PAC) etc. The review has limitations, as the studies are heterogeneous, the meta-analysis requires classifications that can also be arbitrary. Furthermore, single-arm studies are not included. Some of the authors found this evidence inconclusive, which results as a limitation of the study. D mannose prolonged the recurrence-free interval of recurrent UTIs, thus reducing the prolonged or cyclical use of antibiotics, improving clinical symptoms, with a significant difference between treatment and control groups (no treatment, antibiotic prophylaxis, prophylaxis with Proanthocyanidin). However, most clinical trials used an association of different substances commingled with D mannose, dosages and regimens of D mannose were different. For this reason, the evidence of the efficacy of D mannose remains low.

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Nosseir SB, Lind LR, Winkler HA. Recurrent uncomplicated urinary tract infections in women: a review. J Womens Health (Larchmt) 2012;21:347-54.
Epp A, Larochelle A, Lovatsis D, et al. Recurrent urinary tract infection. J Obstet Gynaecol Can 2010;32:1082–119. DOI: https://doi.org/10.1016/S1701-2163(16)34717-X
Nosseir SB, Lind LR, Winkler HA. Recurrent uncomplicated urinary tract infections in women: a review. J Women's Health (Larchmt) 2012;21:347–54. DOI: https://doi.org/10.1089/jwh.2011.3056
Lautenbach E. Editorial commentary: flying under the radar: the stealth pandemic of Escherichia coli sequence type 131. Clin Infect Dis 2013;57:1266-9. DOI: https://doi.org/10.1093/cid/cit505
Bryce A. Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study. J Antimicrobial Chemother 2018;73:1359-67. DOI: https://doi.org/10.1093/jac/dkx525
Simmering JE, Tang F, Cavanaugh JE, et al. The increase in hospitalizations for urinary tract infections and the associated costs in the United States, 1998–2011. Open Forum Infect Dis 2017;4:281. DOI: https://doi.org/10.1093/ofid/ofw281
Beerepoot MA, ter Riet G, Nys S, et al. Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women. Arch Intern Med 2011;171:1270-8. DOI: https://doi.org/10.1001/archinternmed.2011.306
Beerepoot MA, Geerlings S. Non-antibiotic prophylaxis for urinary tract infections. Pathogens 2016;5:E36. DOI: https://doi.org/10.3390/pathogens5020036
Michaels EK, Chmiel JS, Plotkin BJ, Schaeffer AJ. Effect of D-mannose and D-glucose on Escherichia coli bacteriuria in rats. Urol Res 1983;11:97–102.
Harwalkar A, Gupta S, Rao A, Srinivasa H. Prevalence of virulence factors and phylogenetic characterization of uropathogenic Escherichia coli causing urinary tract infection in patients with and without diabetes mellitus. Soc Trop Med Hyg 2015;109:769-74. DOI: https://doi.org/10.1093/trstmh/trv086
Stapleton A, Nudelman E, Clausen H, et al. Binding of uropathogenic Escherichia coli R45 to glycolipids extracted from vaginal epithelial cells is dependent on histo-blood group secretor status. J Clin Investig 1992;90:965–72. DOI: https://doi.org/10.1172/JCI115973
Scholes D, Hawn TR, Roberts PL, et al. Family history and risk of recurrent cystitis and pyelonephritis in women. J Urol 2010;184:564-9. DOI: https://doi.org/10.1016/j.juro.2010.03.139
Costello C, Metcalfe C, Lovering A, et al. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010;340:c2096. DOI: https://doi.org/10.1136/bmj.c2096
Salinas-Casado J, Méndez Rubio S, Esteban Fuertes M, et al. Eficacia y tolerancia terapèutica de la D-Manosa (2 gr.) de liberaciòn prolongada 24 horas (asociada a proantocianidinas), frente a proantocianidinas aisladas en el manejo de una serie de mujeres con infecciones urinarias recurrentes. Arch Esp Urol 2018;71:169-77.
Forbes R, Ali A, Abouhajar A, et al. Alternatives To prophylactic Antibiotics for the treatment of Recurrent urinary tract infection in women (ALTAR): study protocol for a multicentre, pragmatic, patient-randomised, non-inferiority trial. Trials Biomed Central 2018;19:616. DOI: https://doi.org/10.1186/s13063-018-2998-4
Michaels EK, Chmiel JS, Plotkin BJ, Schaeffer AJ. Effect of D-mannose and D-glucose on Escherichia coli bacteriuria in rats. Urol Res 1983;11:97–102. DOI: https://doi.org/10.1007/BF00256954
Raz R, Colodner R, Rohana Y, et al. Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women. Clin Infect Dis 2003;36:1362–8. DOI: https://doi.org/10.1086/374341
Ahmed H, Davies F, Francis N, et al. Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials. BMJ Open 2017;7:e015233. DOI: https://doi.org/10.1136/bmjopen-2016-015233
Porru D, Parmigiani A, Tinelli C, et al. Oral D-mannose in recurrent urinary tract infections in women: a pilot study. J Clinical Urol 2014;7:208‐13. DOI: https://doi.org/10.1177/2051415813518332
Kranjcec B, Papes D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol 2014;32:79–84. DOI: https://doi.org/10.1007/s00345-013-1091-6
Domenici L, Monti M, Bracchi C, et al. D-Mannose: a promising support for acute urinary tract infections in women. A pilot study. Eur Rev Med Pharmacol Sci 2016;20:2920-5.
Phé V, Pakzad M, Haslam C, et al. Open label feasibility study evaluating D-mannose combined with home-based monitoring of suspected urinary tract infections in patients with multiple sclerosis. Neurourol Urodynamics 2017;36:1770–5. DOI: https://doi.org/10.1002/nau.23173
Genovese C, Davinelli S, Mangano K, et al. Effects of a new combination of plant extracts plus d-mannose for the management of uncomplicated recurrent urinary tract infections. Jo Chemother 2018;30:107-14. DOI: https://doi.org/10.1080/1120009X.2017.1393587
Vicariotto F. Effectiveness of an association of a cranberry dry extract, D-mannose, and the two microorganisms lactobacillus plantarum LP01 and lactobacillus paracasei LPC09 in women affected by cystitis a pilot study. J Clin Gastroenterol 2014;48:S96-S101. DOI: https://doi.org/10.1097/MCG.0000000000000224
De Leo V, Cappelli V, Massaro MG, et al. Evaluation of the effects of a natural dietary supplement of cranberry, noxamicin® and d-mannose in recurrent urinary tract infections in perimenopausal women. Minerva Ginecologica 2017;69:336-41.
Palleschi G, Carbone A, Zanello PP, et al. Prospective study to compare antibiosis versus the association of N-acetylcysteine, D-mannose and Morinda citrifolia fruit extract in preventing urinary tract infections in patients submitted to urodynamic investigation. Arch Ital Urol Androl 2017;89:45-50. DOI: https://doi.org/10.4081/aiua.2017.1.45
Marchiori D, Zanello PP. Efficacy of N-acetylcysteine, D-mannose and Morinda citrifolia to treat recurrent cystitis in breast cancer survivals. In Vivo 2017;31:931-6.
Del Popolo G, Nelli F. Recurrent bacterial symptomatic cystitis: A pilot study on a new natural option for treatment. Arch Ital Urol Androl 2018;90:101-3. DOI: https://doi.org/10.4081/aiua.2018.2.101
Altarac S, Papes D. Use of d-mannose in prophylaxis of recurrent urinary tract infections (UTIs) in women. BJU Int 2014;113:9–10. DOI: https://doi.org/10.1111/bju.12492
Milandri R, Maltagliati M, Bocchialini T, et al. Effectiveness of D-mannose, Hibiscus sabdariffa and Lactobacillus plantarum therapy in prevention of infectious events following urodynamic study. Urologia 2019;86:122-5. DOI: https://doi.org/10.1177/0391560318798291
Manno S, Cicione A, Dell'Atti L, et al. Effects of a new combination of cranberry extracts, D-Mannose and GAGs for the management of uncomplicated urinary tract infection. Endocrinol Diabetes Metab J 2019;3:1-4. DOI: https://doi.org/10.31038/EDMJ.2019315
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539-58. DOI: https://doi.org/10.1002/sim.1186
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719-48.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88. DOI: https://doi.org/10.1016/0197-2456(86)90046-2
Panicker J, Phe' V. D-mannose for the Prevention of UTIs in Multiple Sclerosis. 2013. Available from: https://clinicaltrials.gov/show/nct01808755
Ryu G, Aarau K. Preventing recurrent urinary tract infections With α-D-mannose: a Prospective, Randomized, Double-blinded Placebo-controlled Trial (PUTIM). ClinicalTrials.gov identifier (NCT number): NCT03497598.
Zowawi HM, Harris PNA, Roberts MJ et al. The emerging threat of multidrug-resistant Gram-negative bacteria in urology. Nature Reviews Urology 2015;12:570–84. DOI: https://doi.org/10.1038/nrurol.2015.199
Scientific Opinion on the substantiation of a health claim related to a Uroval® and urinary tract infection pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). EFSA J 2009;7:1421. DOI: https://doi.org/10.2903/j.efsa.2009.1421

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Oral D mannose in the prevention and treatment of recurrent urinary tract infections: A review. (2021). Urogynaecologia, 33(1). https://doi.org/10.4081/uij.2021.239

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