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SUFU 2022: The Use of D-Mannose in the Prevention of Recurrent Urinary Tract Infections

(UroToday.com) Current guidelines recommend antibiotic treatment, and in some cases, antibiotic prophylaxis. The possible adverse effects, cost, and increased bacterial resistance to prophylactic antibiotics have led to the study of alternative prevention, such as cranberry, probiotics, and D-mannose. D-mannose is a monosaccharide isomer of glucose rapidly absorbed when given orally and excreted in the urinary tract. It works as a competitive inhibitor of bacterial adherence.


These authors presented the results of a prospective evaluation of 32 patients (23-92 yrs) after six weeks of treatment with D-mannose. Patients were asked about treatment compliance, evidence of recurrent infection, and concomitant therapies. Recurrent infection was defined as symptomatic, culture-proven UTI or symptomatic UTI without culture but with antibiotic use.

After six weeks of therapy, 20 of the patients responded with 14 reporting daily compliance with D-mannose. The remaining 6 reported they were not taking D-mannose. Two patients in the compliant group reported symptomatic, culture-proven UTIs, while the other 12 patients reported no recurrent UTIs. The two patients with recurrent infections were also using antibiotic prophylaxis. On subsequent follow-up at 9-months, 2 patients were lost to follow up and only 6 patients were still taking D-mannose. Two patients reporting daily compliance developed recurrent UTI with a different organism. Another patient taking D-mannose a few times per week experienced recurrent infection with the same organism as previously detected. Only one of the patients with a previous recurrent infection on D-mannose was still compliant at subsequent follow-up and still experiencing recurrent infections. Two patients continued to have no evidence of recurrent infection with daily compliance.

Results indicated that D-mannose reduced the risk of recurrent UTI in these and thus may be a promising prophylactic agent in patients experiencing recurrent UTIs. Further research, including randomized clinical trials, is needed to evaluate the efficacy of D-mannose in the prevention of recurrent UTIs.

Presented by: Alixandra Ryan,1 Hayden Hill, MD,2 Anastasia Couvaras, MD,2 Colin Goudelocke, MD2

  1. The University of Queensland-Ochsner Clinical School
  2. Ochsner Health, Department of Urology

Written by: Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health at the 2022 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting, February 22 - 26, 2022