From the Guidelines
D-mannose should not be recommended for the prevention or treatment of urinary tract infections (UTIs) due to insufficient evidence supporting its effectiveness, as stated in the most recent guidelines 1. The use of D-mannose for UTIs is a topic of ongoing debate, with some studies suggesting potential benefits, but the overall quality of evidence is weak and contradictory.
- The 2024 guidelines from the European Association of Urology recommend using D-mannose to reduce recurrent UTI episodes, but with a weak strength rating and a note that patients should be informed of the overall weak and contradictory evidence regarding its effectiveness 1.
- A 2024 study found insufficient quality of evidence to enable a clear recommendation for the use of D-mannose in preventing UTIs, citing discordant or uncertain results among prospective studies, small sample sizes, and heterogeneity of specific D-mannose regimens 1.
- Other studies have investigated the use of D-mannose, but the evidence is not strong enough to support a definitive recommendation, and the most recent guidelines prioritize other interventions, such as vaginal oestrogen replacement, immunoactive prophylaxis, and antimicrobial prophylaxis, over D-mannose 1. Key points to consider when evaluating the use of D-mannose for UTIs include:
- The lack of high-quality evidence supporting its effectiveness
- The potential for gastrointestinal side effects and other adverse effects
- The importance of consulting a healthcare provider for persistent or severe UTI symptoms, as D-mannose is not a substitute for antibiotics in severe cases or for UTIs caused by bacteria other than E. coli. In clinical practice, it is essential to prioritize interventions with stronger evidence bases, such as those recommended in the 2024 guidelines, and to exercise caution when considering the use of D-mannose for UTIs, given the current state of the evidence 1.
From the Research
Use of D-mannose
- D-mannose is a sugar that can be used to prevent and treat urinary tract infections (UTIs) 2, 3, 4, 5, 6
- The mechanism of action of D-mannose is to prevent bacterial adherence to the uroepithelial cells, thereby preventing infection 2, 4
- D-mannose has been shown to be effective in reducing the incidence of recurrent UTIs and prolonging UTI-free periods, which can improve quality of life 3, 4, 5, 6
Benefits of D-mannose
- D-mannose has been shown to have a significant positive effect on UTIs' resolution and quality of life improvement 6
- D-mannose can be used as a supplementary or alternate treatment for recurrent urinary tract infections 3
- D-mannose appears to be well tolerated with minimal side effects, with only a small percentage of patients experiencing diarrhea 5
Studies on D-mannose
- A systematic review of 7 RCTs found that D-mannose had uncertain effects on symptomatic and bacteriuria-confirmed UTIs when compared to no treatment or antibiotics 2
- A systematic review and meta-analysis found that D-mannose reduced urinary tract infection recurrence compared with placebo, with a pooled relative risk of 0.23 5
- A pilot study found that D-mannose was effective in treating acute urinary tract infections in women and had promising results as a prophylactic agent 6