Why Cranberry & D-Mannose is replacing antibiotics as the agent of choice to fight vaginal infections ?

Bacterial infections of the urinary tract are widespread, with Uropathogenic Escherichia coli (UPEC) being the most prevalent causative agent. Many people experience recurrent UTIs, necessitating preventive antibiotic use for extended periods of time. The worldwide rise of uropathogens resistant to many drugs in the past decade highlights the need for non-antibiotic approaches to treating and preventing UTIs. Colonization, microbial adhesion to uroepithelial cell receptors, and microbial invasion have all been studied as potential targets for non-antibiotic UTI treatments1.

Supplemental D-mannose has shown promise in animal studies as a treatment for urinary tract infections (UTIs) and as a preventative measure against future UTIs. D-mannose, when passed in the urine, has the potential to prevent the most common bacterium that causes urinary tract infections (UTIs), Escherichia coli, from sticking to the urothelium and producing an infection2. Similarly, lactobacillus-containing solutions and cranberry products have shown the most solid results to date and look to be the most highly promising replacement to currently used antibiotics. Larger clinical trials and research into the interactions between non-antibiotic medicines, uropathogenic, and the host immune response are required3.

Role of D-Mannose and Cranberry against Vaginal Infection4:

D-mannose is a natural sugar that can be found in many fresh produce items such as cranberries.  In this way, consuming cranberry in any form (juice, capsules, etc.) will result in the consumption of D-mannose. D-mannose is eliminated from the body after ingestion through the kidneys and subsequently the urinary tract. Because E.coli bacteria  (the main cause of UTIs) binds to D-mannose, thus making the bacteria unable to adhere to cells, grow, and spread infection.

Proanthocyanidins (PACs), another chemical found in cranberries, may be useful in treating urinary tract infections. The PACs prevent E.coli from attaching to cells in the urinary system in a manner similar to that seen with other bacteria. In 2010, researchers found that a daily intake of 36 mg or more of PACs produced the most effective antibacterial activity in the urine5.

D-Mannose vs Cranberry; which is better?

As is so often the case with medical studies, further research is needed into the efficacy of D-mannose and cranberry therapies for UTIs before any firm conclusions can be drawn. However, D-mannose appears to have more substantial results when compared with antibiotics, according to the available data. In addition, whereas D-mannose appears to both prevent6 future infections and reduces symptoms of a present UTI, cranberries' advantages seem to be more on the preventative side.

Although cranberries have shown promising outcomes, the lack of standardised formulations may be limiting those results. Even though the PACs' effects are well established, conflicting study outcomes may be attributable to the wildly different doses of cranberries provided to study participants7.

Can D-Mannose and Cranberry be taken together?

Both cranberry and D-mannose are safe to take together. One study from 2020 found11 that combining D-mannose and cranberry extract improved the efficacy of treatment for simple UTIs when compared to either medication alone. Therefore, while it may be acceptable to take both at the same time, but doing so appears to result in an improved therapeutic outcome8.

References:

  1. Sihra, N., Goodman, A., Zakri, R., Sahai, A. & Malde, S. Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol 15, 750–776 (2018).
  2. Ala-Jaakkola, R., Laitila, A., Ouwehand, A. C. & Lehtoranta, L. Role of D-mannose in urinary tract infections – a narrative review. Nutrition Journal 21, 18 (2022).
  3. Loubet, P. et al. Alternative Therapeutic Options to Antibiotics for the Treatment of Urinary Tract Infections. Frontiers in Microbiology 11, (2020).
  4. D-Mannose vs Cranberry for UTIs - Which is best? The Lowdown Learn more (2022).
  5. Howell, A. B. et al. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infectious Diseases 10, 94 (2010).
  6. Porru, D. et al. Oral D-mannose in recurrent urinary tract infections in women: a pilot study. Journal of Clinical Urology 7, 208–213 (2014).
  7. Hisano, M., Bruschini, H., Nicodemo, A. C. & Srougi, M. Cranberries and lower urinary tract infection prevention. Clinics (Sao Paulo) 67, 661–667 (2012).
  8. Rădulescu, D. et al. Combination of cranberry extract and D-mannose - possible enhancer of uropathogen sensitivity to antibiotics in acute therapy of urinary tract infections: Results of a pilot study. Exp Ther Med 20, 3399–3406 (2020).