Porru D1*, Regina C1, Fiorello N1, Gardella B2, Spinillo A2 and Jallous H1
1Department of Urology, Fondazione IRCCS Policlinico S. Matteo, Italy
2Department of Gynecology and Obstetrics, Fondazione IRCCS Policlinico S. Matteo, Italy
Background: 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. The aim of this review is to address clinical reliability, efficacy and safety of long-term treatment with oral D-Mannose for the prevention of Recurrent Urinary Tract Infections (RUTIs) in females. Materials and Methods: Evidence Acquisition 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." We searched Medline, Embase, Scopus and the Cochrane Register of Controlled Trials since January 2010 to December 2018. Eligible studies did not include non-oral therapy, local (vaginal) treatment in women with RUTIs. We identified eligible original articles. The heterogeneity of the available studies, their different rationale and aim, the assumption of D-mannose for prophylaxis or treatment of recurrent UTIs need to be taken into account. Results: Evidence Synthesis 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. Conclusion: D-mannose prolonged the recurrence-free interval of recurrent UTIs, thus reducing the prolonged or cyclical use of antibiotics, generating an improvement of clinical symptoms, with a significant difference between treatment and control groups (no treatment, antibiotic prophylaxis, prophylaxis with Proanthocyanidin). However, the majority of 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 efficacy of D-mannose remains low.
Recurrent urinary tract infections; Urinary tract infections; D-mannose; Antibiotic prophylaxis; Proanthocyanidin
Porru D, Regina C, Fiorello N, Gardella B, Spinillo A, Jallous H. Oral D-Mannose in the Prevention and Treatment of Recurrent Urinary Tract Infections: A Review. Clin Surg. 2019; 4: 2624.