Abstract
Background: Urinary tract infections (UTI) occur in the urinary tract, most commonly as a result of bacteria, specifically uropathogenic Escherichia coli. UTI presents with unpleasant symptoms such as pain, haematuria, pyuria, fever, and flank pain, and can be further classified as uncomplicated, complicated, and recurrent. Recurrent uncomplicated UTI disproportionately affect women due to anatomical predisposition and the associated contamination with bacteria from the gastrointestinal tract and vaginal microbiome. Current recommendations for recurrent UTI prophylaxis are the use of short- or long-term antimicrobials, however, with the rise of antimicrobial resistance, the consideration of non-antimicrobials for prophylaxis against UTI, specifically D-mannose and cranberry formulations has become a topic of interest.
Aim: This integrative review examined the literature on the efficacy of D-mannose and cranberry formulations as prophylaxis against recurrent UTI in women.
Methodology: An integrative literature review as described by Whittemore and Knafl (2005) was employed to investigate D-mannose and cranberry prophylaxis against recurrent UTI. A systematic search strategy was followed, and a literature search was commenced across five nursing, allied health, and medical databases: Cumulative Index to Nursing Health Literature, the Cochrane Library, pubMed, Medline and Embase Ovid. Quality appraisal was undertaken using Joanna Briggs Institute (2020) tools. In total, ten articles were included in the review. Results: After data analysis and synthesis, three syntheses were identified across the literature. In summary, there was no clear superior formulation for the most effective prophylaxis against recurrent UTI and this prophylaxis was achieved in participants with recurrent uncomplicated and complicated UTI with or without significant risk factors. The results suggest that dosing within a range of 420 mg and 2000 mg of D-mannose, and 60 mg and 500 mg of cranberry demonstrated prophylactic effect against recurrent UTI.
Conclusion: A thorough discussion of the syntheses compared with local guidelines with consideration to the patient and wider community context concluded that D-mannose and cranberry formulations are a safe, viable alternative to antimicrobials for the prophylaxis against recurrent UTI while meeting the goals of antimicrobial stewardship.