D-Mannose for prevention of recurrent urinary tract infection in adult women: An updated systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose: Approximately 50%–60% of adult women experience at least one episode of urinary tract infection (UTI) during their lifetime, with 20%–24% of them experiencing recurrence within a year. Several randomized controlled trials have explored the efficacy and safety of D-mannose for the prevention of UTI in adult women but reported conflicting results. Objective: We performed a meta-analysis comparing D-mannose with placebo or no treatment for the prevention of UTI in adult women. Methods: We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing D-mannose with placebo or no treatment for the prevention of UTI in adult women. The outcomes of interest were recurrent UTIs during follow-up and adverse events. Heterogeneity was assessed using I2statistics. Analysis followed the PRISMA guideline and was registered in the PROSPERO database. Results: The systematic review identified 4 randomized controlled trials (RCTs) including 890 participants (D-mannose n = 447, 50.22%). Recurrent UTI (RR 0.44; 95% CI 0.18–1.11; p = .082; I2= 90%) and adverse events (RR 2.19; 95% CI 0.68–7.05; p = .190; I2= 79%) did not differ significantly between the groups at the end of follow-up. Conclusion: Prophylaxis with D-mannose did not cause any difference in the risk of recurrent UTI during follow-up and adverse events in adult women. Fewer number of studies and heterogeneity in the results make it difficult to draw conclusions about the efficacy of D-mannose in preventing recurrent UTI. More placebo-controlled RCTs are required to confirm the efficacy and safety.