Cranberry Juice Fails to Prevent Recurrent Urinary Tract Infection: Results From a Randomized Placebo-Controlled Trial

Barbosa-Cesnik, Cibele; Brown, Morton B.; Buxton, Miatta; Zhang, Lixin; DeBusscher, Joan; Foxman, Betsy

doi:10.1093/cid/ciq073

Cited by 231 publications

(127 citation statements)

References 25 publications

Supporting

Mentioning

119

Contrasting

Unclassified

Order By: Relevance

“…23 BarbosaCesnik et al 23 used a more frequent dosing regimen and studied a larger sample of predominantly college-age women. The major difference was in the definition of the primary outcome, symptomatic UTI, which in the study by Barbosa-Cesnik et al required culture confirmation.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Urinary Tract Infection and Urinary Escherichia coli in Women Ingesting Cranberry Juice Daily: A Randomized Controlled Trial

Stapleton

Dziura

Hooton

et al. 2012

Mayo Clinic Proceedings

114

View full text Add to dashboard Cite

Objective: To compare the time to urinary tract infection (UTI) and the rates of asymptomatic bacteriuria and urinary P-fimbriated Escherichia coli during a 6-month period in women ingesting cranberry vs placebo juice daily. Patients and Methods: Premenopausal women with a history of recent UTI were enrolled from November 16, 2005, through December 31, 2008, at 2 centers and randomized to 1 of 3 arms: 4 oz of cranberry juice daily, 8 oz of cranberry juice daily, or placebo juice. Time to UTI (symptoms plus pyuria) was the main outcome. Asymptomatic bacteriuria, adherence, and adverse effects were assessed at monthly visits. Results: A total of 176 participants were randomized (120 to cranberry juice and 56 to placebo) and followed up for a median of 168 days. The cumulative rate of UTI was 0.29 in the cranberry juice group and 0.37 in the placebo group (Pϭ.82). The adjusted hazard ratio for UTI in the cranberry juice group vs the placebo group was 0.68 (95% confidence interval, 0.33-1.39; Pϭ.29). The proportion of women with P-fimbriated urinary E coli isolates during the intervention phase was 10 of 23 (43.5%) in the cranberry juice group and 8 of 10 (80.0%) in the placebo group (Pϭ.07). The mean dose adherence was 91.8% and 90.3% in the cranberry juice group vs the placebo group. Minor adverse effects were reported by 24.2% of those in the cranberry juice group and 12.5% in the placebo group (Pϭ.07). Conclusion: Cranberry juice did not significantly reduce UTI risk compared with placebo. The potential protective effect we observed is consistent with previous studies and warrants confirmation in larger, well-powered studies of women with recurrent UTI. The concurrent reduction in urinary P-fimbriated E coli strains supports the biological plausibility of cranberry activity.

show abstract

Section: Discussionmentioning

confidence: 99%

Recurrent Urinary Tract Infection and Urinary Escherichia coli in Women Ingesting Cranberry Juice Daily: A Randomized Controlled Trial

Stapleton

Dziura

Hooton

et al. 2012

Mayo Clinic Proceedings

114

View full text Add to dashboard Cite

show abstract

“…While Jepson et al 47 in their Cochrane Review concluded that there was no evidence for cranberries to prevent UTI, Wang et al 48 found a weak evidence after having excluded one trial as a negative outlier. 49 However, critics rightly argued that this maneuver had caused a bias, as data from a positive outlier study had still been analyzed. 50 Investigators eager to explain negative outcomes of their trials had pointed to unexpectedly low UTI recurrence rates within the chosen observation periods and/or underdosing of the putative active principle.…”

Section: The Mixed Evidence From Clinical Trialsmentioning

confidence: 99%

Cranberry products in the prevention of urinary tract infections: examining the evidence

Nowack¹,

Birck²

2015

BTAT

View full text Add to dashboard Cite

Cranberry (Vaccinium macrocarpon) juice and extracts are widely used and recommended as folk remedy for prophylaxis of urinary tract infections (UTIs). Its putative mechanism is an anti-adhesive effect that prevents docking of bacteria on host tissues. The antiadhesion quality is attributed to A-type proanthocyanidins (PACs), a group of polyphenols that has a restricted occurrence in cranberries and a few related plants. Clinical trials with cranberry have provided a mixed evidence on behalf of UTI prophylaxis. In some trials, a benefit could not be detected due to lower than calculated UTI recurrence rates, in others failure had retrospectively been blamed on underdosing of cranberry products. To circumvent such problems, cranberry products need to be standardized for the bioactive principle of PAC and administered at a sufficient dose. Further characterization of PAC bioavailability, improvement of the currently inconvenient prescriptions, and above all of the palatability for patients is strongly recommended. Larger staged trials should then be carried out in patients with relevant UTI risks.

show abstract

“…Dette avviker fra tidligere systematiske gjennomganger, der man har funnet en viss effekt av tranebaer. Endringen skyldes inklusjon av en rekke nye studier, ikke minst en stor studie som ble publisert i 2011 og som ikke kunne påvise noen effekt (12).…”

Section: Hva Viser Studiene?unclassified

Hvordan forebygge residiverende urinveisinfeksjoner etter menopausen?

Haugen¹,

Spigset²

2015

Tidsskriftet

View full text Add to dashboard Cite

Den nasjonale faglige veilederen for antibiotikabruk i primaerhelsetjenesten sier at metenamin eller lokale østrogener kan ha en forebyggende effekt ved residiverende ukomplisert cystitt hos eldre kvinner og at kontinuerlig antibiotikaprofylakse bør unngås. Siden veilederen ikke gir konkrete råd om prioriteringsrekkefølge eller oppfølging, ønsker vi her å problematisere valg av legemiddel og diskutere hvordan behandlingen kan skje i praksis.Residiverende urinveisinfeksjoner defineres som tre eller flere tilfeller med urinveisinfeksjoner i løpet av et år. Postmenopausale kvinner er spesielt utsatt (1, 2). Infeksjonene forårsakes i opp mot 80 % av tilfellene av Escherichia coli. Andre vanlige bakterietyper er Enterococcus faecalis, Klebsiella pneumoniae og Proteus mirabilis. I sykehjem opptrer E. coli, Klebsiella og Proteus hyppigst, hvorav sistnevnte utgjør 10 % (1, 3). Antibiotikaresistens er et økende problem. I Norge er omtrent 20 % av E. coli-isolatene fra urinprøver resistente mot trimetoprim (4).En norsk prevalensstudie fra 2011 fant at 18 % av i alt 1 473 sykehjemsbeboere fikk forebyggende behandling for urinveisinfeksjon (5). Av dem som fikk behandling brukte 74 % ett middel og 26 % to eller flere midler. Det vanligste preparatet var metenamin (48 %), fulgt av vitamin C (32 %), peroralt østrogen (21 %), tranebaer (10 %), vaginalt østrogen (9 %), trimetoprim (5 %) og nitrofurantoin (4 %) (5). En av fem av dem som fikk metenamin i denne studien ble også behandlet med vitamin C (Jenny Bergmann, personlig meddelelse). Forbruket i den generelle befolkningen på denne indikasjonen er ikke mulig å angi for andre midler enn metenamin, siden de andre midlene også brukes på andre indikasjoner. For metenamin tilsvarer salget i Norge at rundt regnet 1 av 300, eller ca. 17 000 individer, bruker midlet til enhver tid. Hvis situasjonen i den generelle befolkningen tilsvarer den på sykehjem, kan man anta at rundt halvparten av alle med residiverende urinveisinfeksjoner behandles med metenamin, de øvrige med andre midler. Er dette en rasjonell fordeling? Hvor god er dokumentasjonen?Cochrane-gruppen har publisert systematiske litteraturgjennomganger og metaanalyser for metenamin, østrogener, antibiotika og tranebaer som profylakse ved residiverende urinveisinfeksjoner hos ulike pasientgrupper, inklusive postmenopausale kvinner (6 -9). Generelt påpekes det at originalstudiene har betydelige metodologiske mangler (åpne eller enkeltblindede studier med uortodokse inklusjonskriterier, tvilsomme randomiseringsprosedyrer og uklare endepunkter). Dessuten er mange studier gamle og har få pasienter inkludert. Dermed blir effektestimatene i Cochrane-gjennomgangene tilsvarende usikre. Litteraturgjennomgangene på området konkluderer gjerne med at det trengs flere, større og bedre designede studier, men slike utsagn er ikke til hjelp i den kliniske hverdagen. Hvis man skal kreve store, veldesignede og konklusive studier før man gir noen form for behandling, kan det føre til behandlingsnihilisme. En mer pragmatisk tilpasning kan vaere å ...

show abstract

Cranberry Juice Fails to Prevent Recurrent Urinary Tract Infection: Results From a Randomized Placebo-Controlled Trial

Cited by 231 publications

References 25 publications

Recurrent Urinary Tract Infection and Urinary Escherichia coli in Women Ingesting Cranberry Juice Daily: A Randomized Controlled Trial

Recurrent Urinary Tract Infection and Urinary Escherichia coli in Women Ingesting Cranberry Juice Daily: A Randomized Controlled Trial

Cranberry products in the prevention of urinary tract infections: examining the evidence

Hvordan forebygge residiverende urinveisinfeksjoner etter menopausen?

Contact Info

Product

Resources

About