Recurrent urinary tract infection (UTI) is not reduced in primary care from daily d-mannose, according to a recent study published in JAMA Internal Medicine.1
Takeaways
- Daily supplementation with d-mannose does not significantly reduce the incidence of recurrent urinary tract infections (UTIs) in women, as per the recent study.
- UTIs are the most common bacterial infection among women in primary care, with a lifetime risk of up to 50%.
- In a double-blind, placebo-controlled randomized clinical trial, 51% of women taking d-mannose and 55.7% of those taking a placebo reported additional UTI episodes, showing no significant difference.
- There was no significant difference in the severity of UTI symptoms, time to next consultation, or antibiotic usage between the d-mannose and placebo groups.
- Clinicians should be cautious with d-mannose use, especially in patients with diabetes or insulin resistance, because of potential adverse effects on insulin secretion.
The lifetime risk of UTI is up to 50%, making it the most common bacterial infection among women in primary care. Recurrent UTI (rUTI) is defined as 2 UTIs in 6 months or 3 in a year. Patients’ quality of life is often adversely impacted, with over 200,000 UTI deaths reported worldwide in 2019.
Patients often administer daily antibiotics for rUTI prophylaxis, but this method increases resistant UTI and adverse effect risks. The food supplement d-Mannose may be an alternative to antibiotic prophylaxis in women with rUTI. However, high costs of d-mannose indicate a need to determine whether family physicians should advise purchase among patients.
To evaluate the efficacy of d-mannose against rUTI, investigators conducted a double-blind, placebo-controlled randomized clinical trial. Recruitment was performed across 99 primary care centers in 10 of 15 regions in England and 4 of 7 health boards in Wales.
Participants included women aged 18 years or older presenting to an ambulatory care system consistent with a UTI or resulting in a UTI-specific antibiotic prescription at least 3 times in the prior year or 2 times in the prior 6 months. Exclusion criteria included pregnancy, lactating, overactive bladder syndrome, and residing in a nursing home.
Participants were randomized to receive d-mannose or placebo, taking either 2 g of d-mannose or a similar scoop of fructose powder daily. Use of the study product continued when participants were symptomatic and when taking antibiotics.
UTI symptoms, over-the-counter medicine use, health care contacts, and EuroQol EQ-5D-5L instrument were recorded daily by patients in a symptom diary. Women with continuous, mild UTI also completed the diary when experiencing symptom flares. When the diary was not completed, data was obtained from a weekly questionnaire.
The proportion of women experiencing 1 or more additional UTI episode leading to ambulatory care was the primary outcome of the analysis. This outcome was recorded within 6 months of randomization.
The number of days with moderately bad or worse symptoms, time to next consultation, number of clinically suspected UTIs, number of microbiologically proven UTIs, antibiotic courses, defined daily dose, proportion of women with resistant uropathogens, and UTI hospital admissions were reported as secondary outcomes.
