Dmn8.5

D-Mannose Research

40 peer-reviewed studies · Evidence score: 8.5/10

Nonantibiotic prophylaxis for urinary tract infections: a network meta-analysis of randomized controlled trials

Han Z et al. • Infection (2025)

D-mannose, triple therapy, vaccine, probiotics, and cranberry serve as potential nonantibiotic intervention options for clinical UTI prevention.

Nearly 80% of the RCTs utilized double-blind or triple-blind designs.
D-mannose, triple therapy, vaccine, probiotics, and cranberry serve as potential nonantibiotic intervention options for clinical UTI prevention.
Further research warranted to confirm findings

Meta-Analysisn=10,495

DOI

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

Vargas CEF et al. • Jornal brasileiro de nefrologia (2025)

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.

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).
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.

Meta-Analysisn=1,167

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D-mannose for preventing and treating urinary tract infections

Cooper TE et al. • The Cochrane database of systematic reviews (2022)

There is currently little to no evidence to support or refute the use of D-mannose to prevent or treat UTIs in all populations.

There is currently little to no evidence to support or refute the use of D-mannose to prevent or treat UTIs in all populations.
This review highlights the severe lack of high-quality RCTs testing the efficacy of D-mannose for UTIs in any population.
Despite UTIs being one of the most common adult infections (affecting 50% of women at least once in their lifetime) and the growing global antimicrobial resistance, we found very few studies that adequately test this alternative treatment.

Systematic Reviewn=719

DOI

Role of D-Mannose in the Prevention of Recurrent Urinary Tract Infections: Evidence from a Systematic Review of the Literature

Kyriakides R et al. • European urology focus (2021)

D-Mannose improved quality of life and significantly reduced recurrent UTIs in both catheter and non-catheter users.

D-Mannose improved quality of life and significantly reduced recurrent UTIs in both catheter and non-catheter users.
It also leads to a longer duration between episodes of recurrences and consequently improves patient quality of life.
D-Mannose can be used as a supplementary or alternate treatment for recurrent urinary tract infections.

Systematic Reviewn=695

DOI

Probiotics: utility, benefits, and risks for gynecologic conditions

Carmain M et al. • Current opinion in obstetrics & gynecology (2025)

More research is necessary to recommend specific bacterial strains or products for each indication.

Systematic review examining D-Mannose efficacy
Further research warranted to confirm findings

Systematic Review

DOI

Optimizing Prevention of Recurrent Urinary Tract Infections in Older Patients with Frailty

Hjelholt TJ et al. • Drugs & aging (2025)

The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Prophylactic antibiotic use may reduce recurrence in selected patients but carries significant risks, including Clostridioides difficile infection and antimicrobial resistance.
Clinical decision-making should be guided by individualized risk assessment, careful consideration of treatment burden, and regular reassessment of both benefits and harms.
Further research is urgently needed to inform evidence-based prevention strategies for this vulnerable population.

Systematic Review

DOI

Emerging Non-Antibiotic Options Targeting Uropathogenic Mechanisms for Recurrent Uncomplicated Urinary Tract Infection

Chen YC et al. • International journal of molecular sciences (2023)

Additional clinical trials are warranted to validate the therapeutic efficacy and durability of these techniques.

Even without underlying anatomic or functional abnormalities, more than 40% of women experience at least one UTI in their lifetime, of which 30% develop recurrent UTIs (rUTIs) within 6 months.
The adaptive evolution of UPEC has been observed in several aspects, including colonization, attachment, invasion, and intracellular replication to invade the urothelium and survive intracellularly.
Combination therapies targeting multiple pathogenic mechanisms are expected to be a future trend in UTI management, although some of these treatment options have not been well established in terms of their long-term efficacy.

Systematic Review

DOI

Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials

Ahmed H et al. • BMJ open (2017)

Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI.

Long-term antibiotics reduced the risk of UTI recurrence by 24% (three trials, n=482; pooled risk ratio (RR) 0.76; 95% CI 0.61 to 0.95, number needed to treat=8.5).
There was no statistically significant increase in risk of adverse events (mild adverse events: pooled RR 1.52; 95% CI 0.76 to 3.03; serious adverse events: pooled RR 0.90, 95% CI 0.31 to 2.66).
One trial showed 90% of urinary and faecal Escherichia coli isolates were resistant to trimethoprim-sulfamethoxazole after 1 month of prophylaxis.

Meta-Analysisn=150

DOI

The Impact of Glycolysis and Its Inhibitors on the Immune Response to Inflammation and Autoimmunity

Pająk B et al. • Molecules (Basel, Switzerland) (2024)

Here, we discuss the role of glycolysis in immune cell activity in physiological and pathological conditions, and the potential use of inhibitors of glycolysis for disease treatment.

Different immune cells exhibit cell-type-specific metabolic patterns when performing their biological functions.
Numerous published studies have shed more light on the importance of metabolic reprogramming in the immune system.
Moreover, this knowledge is crucial for revealing new ways to target inflammatory pathologic states, such as autoimmunity and hyperinflammation.

Systematic Review

DOI

Literature Review of Ascorbic Acid, Cranberry, and D-mannose for Urinary Tract Infection Prophylaxis in Older People

Song G et al. • The Senior care pharmacist (2023)

For those who are interested in trying these products despite the lack of robust evidence for clinical efficacy, it may be helpful to know that the studies included in this review did not identify any clinically important signs of harm, to the extent that safety data were documented and reported.

This review captured all studies in previous reviews as well as recent publications.
The authors determined that there were limited data for D-mannose and vitamin C, and randomized data for cranberry as defined by the classification system.
Conclusions The three supplements reviewed appear not to be strongly supported by clinical data.

Systematic Reviewn=24

DOI

D-mannose vs other agents for recurrent urinary tract infection prevention in adult women: a systematic review and meta-analysis

Lenger SM et al. • American journal of obstetrics and gynecology (2020)

D-mannose appears protective for recurrent urinary tract infection (vs placebo) with possibly similar effectiveness as antibiotics.

Pooled relative risk of urinary tract infection recurrence comparing D-mannose to placebo was 0.23 (95% confidence interval, 0.14-0.37; heterogeneity=0%; D-mannose n=125, placebo n=123).
Pooled relative risk of urinary tract infection recurrence comparing D-mannose to preventative antibiotics was 0.39 (95% confidence interval, 0.12-1.25; heterogeneity=88%; D-mannose n=163, antibiotics n=163).
D-mannose appears protective for recurrent urinary tract infection (vs placebo) with possibly similar effectiveness as antibiotics.

Meta-Analysisn=103

DOI

Role of D-mannose in urinary tract infections - a narrative review

Ala-Jaakkola R et al. • Nutrition journal (2022)

This systematic-review examined the effects of D-Mannose.

When excreted in urine, D-mannose potentially inhibits Escherichia coli, the main causative organism of UTIs, from attaching to urothelium and causing infection.
In this review, we provide an overview of UTIs, E. coli pathogenesis and D-mannose and outline the existing clinical evidence of D-mannose in reducing the risk of UTI and its recurrence.
Furthermore, we discuss the potential effect mechanisms of D-mannose against uropathogenic E.coli.

Systematic Review

DOI

Non-antibiotic Approaches to Preventing Pediatric UTIs: a Role for D-Mannose, Cranberry, and Probiotics?

Ching CB • Current urology reports (2022)

More studies are required in the utility of each treatment, with some emphasis on larger sample sizes and clarifications regarding dosing and formulation.

Systematic review examining D-Mannose efficacy
Further research warranted to confirm findings

Systematic Review

DOI

Nonantibiotic prevention and management of recurrent urinary tract infection

Sihra N et al. • Nature reviews. Urology (2018)

A combination of these agents might provide the optimal treatment to reduce recurrent UTI, and trials in specific population groups are required.

The growing problem of antimicrobial resistance means that the search for nonantibiotic alternatives for the treatment and prevention of UTI is of critical importance.
Some of the results of trials of these approaches are promising; however, high-level evidence is required before firm recommendations for their use can be made.
A combination of these agents might provide the optimal treatment to reduce recurrent UTI, and trials in specific population groups are required.

Systematic Review

DOI

Recurrent urinary tract infections: from pathogenesis to prevention

Pigrau C et al. • Medicina clinica (2020)

Urinary tract infections are highly prevalent among women and when they are recurrent they can lead to patient discomfort and high healthcare costs, and they represent one of the most frequent caus...

Urinary tract infections are highly prevalent among women and when they are recurrent they can lead to patient discomfort and high healthcare costs, and they represent one of the most frequent causes of antibiotic consumption.
Further research warranted to confirm findings

Systematic Review

DOI

New and potential strategies for the treatment of PMM2-CDG

Gámez A et al. • Biochimica et biophysica acta. General subjects (2020)

Treatments based on increasing Man-1-P levels have been proposed, along with the administration of different mannose derivates, employing enzyme inhibitors or repurposed drugs to increase the synthesis of GDP-Man.

Treatments based on increasing Man-1-P levels have been proposed, along with the administration of different mannose derivates, employing enzyme inhibitors or repurposed drugs to increase the synthesis of GDP-Man.
A single repurposed drug that might alleviate a severe neurological symptom associated with the disorder is now in clinical use.
Proof of concept also exists regarding the use of pharmacological chaperones and/or proteostatic regulators to increase the concentration of hypomorphic PMM2 mutant proteins.

Systematic Review

DOI

Nonantibiotic treatments for urinary cystitis: an update

Barea BM et al. • Current opinion in urology (2020)

The reason for this is largely due to a lack of good-quality randomized controlled trials on this subject.

Systematic review examining D-Mannose efficacy
Further research warranted to confirm findings

Systematic Review

DOI

Prevention and treatment of uncomplicated lower urinary tract infections in the era of increasing antimicrobial resistance-non-antibiotic approaches: a systemic review

Wawrysiuk S et al. • Archives of gynecology and obstetrics (2019)

The last 20 years of research on non-antibiotic approaches in UTI have not brought conclusive evidence that antibiotic usage can be replaced completely by non-antibiotic options.

The last 20 years of research on non-antibiotic approaches in UTI have not brought conclusive evidence that antibiotic usage can be replaced completely by non-antibiotic options.
Hence, antibiotics still remain a gold standard for UTI treatment and prevention.
However, changing the therapeutic strategy by including non-antibiotic measures in the management of UTI could be successful in avoiding antimicrobial resistance at least to some extent.

Systematic Review

DOI

[Recurrent cystisis: No medicine preventive means]

Armelle J • Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie (2017)

Using prophylactic treatment still have an interest, even if they are questionable.

Using prophylactic treatment still have an interest, even if they are questionable.
Moreover, the combination of these methods (diet and lifestyle advice) can be an alternative to long-term prophylactic medical treatment.
Further research warranted to confirm findings

Systematic Review

DOI

Oral preparation of hyaluronic acid, chondroitin sulfate, N-acetylglucosamine, and vitamin C improves sexual and urinary symptoms in participants with recurrent urinary tract infections: a randomized crossover trial

Boeri L et al. • The journal of sexual medicine (2024)

The oral formulation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C could be an effective therapy against urinary and sexual distress in participants with rUTI (NCT06268483; ClinicalTrials.gov).

Overall, 27 (54%) participants had an FSFI score <26.5 at enrollment.
However, after crossover, the control group showed a significant improvement in IPSS and FSFI scores (all P < .01) vs the 3-month assessment.
The oral formulation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C could be an effective therapy against urinary and sexual distress in participants with rUTI (NCT06268483; ClinicalTrials.gov).

Crossovern=2,023

DOI

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