In our study, D-mannose powder had significantly reduced the risk of recurrent UTI which was no different than in Nitrofurantoin group. More studies will be needed to validate the results of this study, but initial findings show that D-mannose may be useful for UTI prevention.

Introduction: Fournier’s gangrene (FG) is the necrotizing fasciitis of the perineum and genital area with high mortality. Materials and Methods: A retrospective review included 41 patients diagnosed with FG in our hospitals from 1995 to 2010, divided into survivors and nonsurvivors. We analyzed anamnestic, clinical and laboratory data. Results: The mortality rate was 36.6% (15/41 patients). Elevated heart and respiratory rates, high serum creatinine, low serum bicarbonate, pre-existing kidney disease, and higher median extent of affected body surface were associated with higher mortality. Severe sepsis on admission and hypotension below 90 mm Hg were also predictive for higher mortality. The median FG severity index (FGSI) score was higher in nonsurvivors (11 compared to 6, p < 0.0001). No cases of testicular necrosis were noted. Conclusion: Besides standard clinical and laboratory parameters included in the FGSI calculation, higher extent of affected body surface area and presence of hypotension on admission were also positively associated with mortality.

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Recurrent UTIs, defined as at least two UTIs in 6 months or three UTIs in 1 year, are a significant burden for the patient and result in high costs to the health system. There are several options for preventing recurrent UTIs, including antibiotic prophylaxis, methenamin prophylaxis and topical oestrogen. The two most commonly used strategies are long-term low-dose antibiotic prophylaxis and post-coital antibiotic prophylaxis for women who have UTI associated with sexual intercourse. Large reviews have shown that antibiotic prophylaxis lasting from 6 to 12 months (or even longer) significantly reduces the number of clinical recurrences in women with recurrent UTIs, but there is no consensus on when to start the prophylaxis, on how long it should last or at which dose and schedule the antibiotic should be taken. Several prophylactic antibiotic regimens can be used with the same efficiency. The most commonly prescribed regimens are trimethoprim-sulfamethoxazole (or trimethoprim alone), nitrofurantoin, cephalexin and the fluoroquinolones at a quarter of the usual daily dose for 6 months. The downsides of long-term antibiotic prophylaxis are possible adverse reactions (although rare), costs and increasing bacterial resistance to antibiotics; therefore, alternative prophylactic agents, such as cranberry juice and probiotics have been extensively studied. One such agent is D-mannose, which is normally present in human metabolism and has an important role, especially in the glycosylation of certain proteins. The supposed mechanism of action is inhibition of bacterial adherence to urothelial cells. In vitro experiments have shown that D-mannose binds and blocks FimH adhesin, which is positioned at the tip of the type 1 fimbria of enteric bacteria. During bacterial colonization, FimH binds to carbohydrate-containing glycoprotein receptors on the epithelium of the urinary tract. As it is similar in structure to the binding site of urothelial glycoprotein receptors, D-mannose acts as a competitive inhibitor of bacterial adherence; in sufficient concentration in urine D-mannose causes saturation of FimH adhesins and prevents the bacteria from binding to urothelial receptors. As well as in vitro, reduction of bacteriuria levels has also been confirmed in in vivo animal UTI models [1]. A similar anti-adhesive effect mechanism has been suggested for Tamm D-mannose powder has been available for some time for the treatment of UTIs in horses, cats and dogs. Its efficiency has not been validated in larger studies but it has been shown that in vitro D-mannose applied locally reduces the adherence of Escherichia coli, Pseudomonas aeruginosa and Streptococcus zooepidemicus (important causes of sterility in mares) to endometrial epithelial cells in mares [4]. D-mannose is also widely available and used for UTI prevention in humans as a food supplement, but clinical studies on the topic are lacking; therefore, in 2012, after obtaining institutional ethics board approval, we conducted a clinical trial that included 308 women >18 years o...