Efficacy of D-mannose as prophylaxis of recurrent urinary tract infection: a systematic review and meta-analysis of randomized controlled trials

Abstract

Introduction:  Recurrent urinary tract infections (UTIs) significantly impact the quality of life due to symptoms, effects on sexual activity, persistent pain, and recurrent antibiotic use. This systematic review and meta-analysis aimed to evaluate the efficacy of D-mannose in preventing recurrent UTIs.

Methods:  In May 2024, we systematically searched PubMed, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) comparing D-mannose treatment with no intervention or standard antibiotic therapy in patients at high risk for recurrent UTI. We applied a random-effects model to pool relative risks (RR) and 95% confidence intervals (CI).

Results:  We included 6 RCTs comprising 1,167 participants, of whom 534 received D-mannose and 521 (97.6%) were women. D-mannose was not associated with a reduction in recurrent UTI compared with control (RR: 0.57, 95% CI 0.29 – 1.15; p < 0.01) or antibiotics (RR: 0.39, 95% CI 0.12 – 1.25; p < 0.01). Further analyses showed that D-mannose did not improve outcomes in a subgroup of postmenopausal women.

Conclusion:  In this meta-analysis of RCTs, D-mannose did not reduce the incidence of recurrent UTIs compared with control or antibiotics in high-risk patients.

Keywords:
Mannose; Antibiotic Prophylaxis; Urinary Tract Infections; Systematic Review; Meta-Analysis