D - mannose for recurrent UTIs
Last edited 11/2018 and last reviewed 01/2023
D-mannose for prevention and treatment of UTIs
- D-mannose is a simple sugar, a monosaccharide extracted from larch rod,
closely related to glucose
- several fruits and vegetables contain D-mannose, including:
- cranberries (and cranberry juice)
- apples
- oranges
- peaches
- broccoli
- green beans
- D-mannose is rapidly absorbed and in about 30 minutes reaches the peripheral organs, then is excreted by the urinary tract
- D-mannose cannot be transformed into glycogen, therefore, is not stored in the body
- long-term use of D-mannose, in concentrations up to 20%, has not shown
any side effect on human metabolism (1)
- several fruits and vegetables contain D-mannose, including:
- the process of bacterial adhesion on the cell surface is a crucial factor
for the onset of most infections
- occurs because specific lectins on bacterial wall are able to bind molecules
such as D-mannose and L-fucose distributed on the human cell surface
- the bladder wall is coated with various mannosilate proteins, such
as Tamm-Horsfall protein (THP) that interfere directly with the adhesion
of bacteria on the mucosa
- THP may fasten to E. coli with a specific bond, which may be inhibited by exogenous D-mannose
- by inhibiting the adhesion of bacteria to the urothelium, D-mannose mimics urothelial barrier function
- binding free D-mannose in the urine rather than proteins on
the vescical cells surface, bacteria are trapped in the urinary
flow and consequently eliminated by the urinary tract
- the bladder wall is coated with various mannosilate proteins, such
as Tamm-Horsfall protein (THP) that interfere directly with the adhesion
of bacteria on the mucosa
- occurs because specific lectins on bacterial wall are able to bind molecules
such as D-mannose and L-fucose distributed on the human cell surface
- NICE was aware of the mechanism of action of D-mannose, which is also in
cranberry products
- noted evidence suggesting that D-mannose was effective in reducing the risk of recurrent UTI in non-pregnant women, and noted the low NNT of 3 (range 2 to 3) over 6 months, compared with no treatment (2)
- however, this was based on 1 small RCT (3)
- D-mannose (200 ml of 1% solution once daily in the evening) used
for up to 6 months significantly reduced the risk of recurrent infection
in non-pregnant women compared with no treatment (14.6% versus 60.8%,
NNT 3 [range 2 to 3]; high quality evidence)
- based on 1 RCT in non-pregnant women presenting with a current UTI and a history of recurrent UTI
- D-mannose (200 ml of 1% solution once daily in the evening) used
for up to 6 months significantly reduced the risk of recurrent infection
in non-pregnant women compared with no treatment (14.6% versus 60.8%,
NNT 3 [range 2 to 3]; high quality evidence)
- a study by Domennici et al suggest that D-mannose can be an effective
aid in acute cystitis management and also a successful prophylactic agent
in a selected population (4)
- NICE made a recommendation that some women who are not pregnant may wish to try D-mannose, as a self-care treatment, noting the sugar content of this product which should be considered
Reference:
- Rosen DA et al. Molecular variations in Klebsiella pneumonia and Escherichia coli FimH affect function and pathogenesis in the urinary tract. Infect Immun 2008; 76: 3346-3356
- NICE (October 2018). Urinary tract infection (recurrent): antimicrobial prescribing
- 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 Feb;32(1):79-84. doi: 10.1007/s00345-013-1091-6. Epub 2013 Apr 30.
- Domenici L et al. D-mannose: a promising support for acute urinary tract infections in women. A pilot study. Eur Rev Med Pharmacol Sci. 2016 Jul;20(13):2920-5.
cranberry juice for preventing urinary tract infections (UTI)