A Randomized Controlled Trial Comparing a New D-Mannose-based Dietary Supplement to Placebo for the Treatment of Uncomplicated Escherichia coli Urinary Tract Infections

Fabrication of levofloxacin-loaded porcine acellular dermal matrix hydrogel and functional assessment in urinary tract infection

“…The lipopolysaccharides (LPS) present on its surface bind to the TLR4 receptors located on the epithelial cells of the bladder, thereby initiating the activation of IKK and facilitating the translocation of NF-κB into the nucleus. This sequential process ultimately leads to the regulation of various pro-inflammatory cytokines, including IL-1β, TNF-α, and IL-6 [9,[64][65][66][67]. Consequently, the activation of Ly6C − macrophages and mast cells occurs, while neutrophils and Ly6C + macrophages are recruited to eliminate uropathogenic E.coli (UPEC) that has invaded the bladder epithelial cells [68].…”

D-Mannose Plus Saccharomyces boulardii to Prevent Urinary Tract Infections and Discomfort after Cystoscopy: A Single-Center Prospective Randomized Pilot Study

“…Bacteriological resolution was also higher in the DAPAD group at day 6 (85.7% vs. 14.3%; p < 0.0001) and day 35 (100% vs. 40%; p < 0.0001). Only few mild adverse events (4.26%) unrelated to the investigated product were recorded [ 10 ]. Pugliese et al investigated in a pilot study on 33 patients if the combination of D-Mannose, pomegranate extract, prebiotics, and probiotics was effective in modifying the symptoms reported by women with acute uncomplicated acute cystitis.…”

“…Although these competitive antagonists preventing pathogen adhesion seem to be promising antimicrobial agents, the molecular mechanisms underlying these complex adhesion processes are still poorly understood [ 7 , 8 ]. Several studies have provided evidence supporting the efficacy of D-Mannose in the prevention and treatment of UTIs [ 7 , 9 , 10 ]. A recent review by De Nunzio et al reported that most of the papers available on the topic demonstrate that D-Mannose can play a role in the prevention of recurrent UTIs or iatrogenic UTIs (i.e., urodynamics-associated), and its effect, in some cases, can be comparable to that of antibiotics; several articles proved that the combination of D-Mannose with other substances (including probiotics) could enhance efficacy in preventing UTIs without compromising patient safety [ 7 ].…”

It’s uncomplicated: Prevention of urinary tract infections in an era of increasing antibiotic resistance

“…Some groups are studying D-mannose in combination with other components to treat, rather than prevent UTIs. For example, Salvatore and colleagues [ 29 ] recently reported the results of a single-center, randomized, double-blind, placebo-controlled trial in 70 women (35 per group) of DAPAD, a mixture of D-mannose, citric acid, prebiotic fiber, Astragalus , and dandelion, for the oral treatment of uncomplicated UTI. They saw clinical resolution in a third of treated patients versus none in the placebo group at 6 days ( p < 0.0001) and in over 88% of treated patients versus 20% in the placebo group at day 35 ( p < 0.0001).…”

“…One limitation of this vaccine is the lengthy regimen-daily doses for 3 months-needed to stimulate effective immunity. Mannosides Chemically modified versions of mannose that have high affinity for the FimH protein on E. coli fimbriae, blocking adhesion to the urothelium [28] DAPAD complex A mixture of D-mannose, citric acid, prebiotic fiber, Astragalus, and dandelion [29] Cranberry juice or supplements Contains D-mannose and proanthocyanidins that may prevent bacteria from binding to the urothelium [30] Probiotics Beneficial bacteria such as Lactobacilli restore the vaginal flora and may prevent the growth of pathogenic bacteria causing UTIs [31] Vaccines Vaccines against common UTI pathogens are in development and could prevent recurrent infections [26] Topical estrogen For postmenopausal women, might help rebalance the vaginal flora and reduce the risk of recurrent UTIs [25] Herbal remedies Uva Ursi (Bearberry) Goldenseal Horsetail…”