March 2021 Article Posted on DukeHealth site Entitled “Goodbye UTIs: Duke scientists develop vaccine strategy for urinary tract infections. In test mice, the vaccine administered directly to the bladder cleared bacteria.

Author: Sarah Avery

Summary:  Anyone who has ever developed a urinary tract infection (UTI) knows that it can be painful, pesky, and persistent. UTIs have a high recurrence rate and primarily afflict women — as many as 50% of women will experience at least one UTI during their lifetime. However, what if patients could take a vaccine that would prevent future UTIs? In a March 1 study in the Proceedings of the National Academy of Sciences, Duke researchers describe a new vaccination strategy that they think could re-program the body to fight off the bacteria that cause urinary tract infections successfully.

September 2020 Article Posted on National Institutes of Health (NIH) Site Entitled “Role of D-Mannose in the Prevention of Recurrent Urinary Tract Infections: Evidence from a Systematic Review of the Literature”

Authors: Rina Kyriakides, Patrick Jones, Baskar K. Somani

Summary: We performed a systematic review to assess the effect of D-mannose in the prevention of recurrent UTIs. Of the eight studies reporting on D-mannose in this context, six were clinical and included 695 individuals. Three studies reported that time to UTI recurrence was longer with D-mannose. D-Mannose improved quality of life and significantly reduced recurrent UTIs in both catheter and non-catheter users. D-Mannose was effective in reducing the incidence of recurrent UTIs and prolonging UTI-free periods, which consequently increased quality of life.

June 2020 Article Posted on National Institutes of Health (NIH) Site Entitled Use of D-mannose in the prevention of recurrent lower urinary tract infection in women”

Authors: Kuzmenko, Gyaurgiev

Summary: D-mannose use for the prevention of relapses of INMP is indicated in the clinical recommendations of the American (AUA) and European (EUA) urological associations. The data presented in the literature allow us to recommend patients with recurrent LUTI long term D-mannose intake helps to reduce the severity of symptoms in acute episodes and prolong relapse-free period.

January 2020 Article Posted on National Institutes of Health (NIH) Site Entitled “D-Mannose Treatment neither Affects Uropathogenic Escherichia coli Properties nor Induces Stable FimH Modifications”

Authors: Daniela Scribano, Meysam Sarshar, Carla Prezioso, Marco Lucarelli, Antonio Angeloni, Carlo Zagaglia, Anna Teresa Palamara, and Cecilia Ambrosi

Summary: Overall, the low metabolic/energetic advantages for bacterial growth, the lack of selection of altered FimH adhesins after long-term d-mannose exposure, and the bladder cell tolerance emphasize the safe use of d-mannose in the treatment and prevention of UTIs caused by UPEC (Uropathogenic Escherichia coli)

August 2020 Article in VeryWell Health Entitled “The Health Benefits of D-Mannose”

Reviewed By Lana Butner,ND

Summary: As a dietary supplement, D-Mannose is often touted as a natural way to treat and prevent a urinary tract infection (UTI) or bladder infection (cystitis). Since treatment for frequent UTIs is long-term low-dose antibiotic use (six months or longer), having a non-antibiotic treatment for this type of infection—which accounts for more than six million doctor visits a year—would help prevent antibiotic resistance.

August 2020 Article in the American Journal of Obstetrics and Gynecology entitled “D-Mannose versus Other Agents for Recurrent Urinary Tract Infections Prevention in Adult Women”

Authors: Stacy M. Lenger, MD; Megan S. Bradley, MD; Debbie A. Thomas, MLS; Marnie H. Bertolet, PhD; Jerry L. Lowder, MD, MSc; Siobhan Sutcliff, PhD, SCM, MHS

Summary: D-mannose appears protective for recurrent urinary tract infection (vs placebo) with possibly similar effectiveness as antibiotics. Overall, D-mannose appears well tolerated with minimal side effects—only a small percentage experiencing diarrhea. Meta-analysis interpretation must consider the small number of studies with varied study design and quality and the overall small sample size.

July 2020 Article on Women’s Wellness entitled “UTI Treatment Without Antibiotics”

Reviewed by Daniel Murrell M.D.

Summary: D-mannose is a sugar that sticks to E. coli. Recently, researchers have studied the possibility of using D-mannose and other mannose-containing substances to block the binding of FimH to the lining of the urinary tract. One small, limited study from 2014 showed positive results when attempting to prevent recurrent UTIs. More research is needed, but potentially, a medication that utilizes a mannose-containing substance that opposes FimH from attaching to the lining of the urinary tract in one way or another could show promise for the treatment of UTIs caused by E. coli.

November 2019 Article in Healthline Medical News Entitled “Can D-Mannose Treat or Prevent UTIs?”

Author: Alan Carter PharmD

Summary: More research needs to be done, but D-mannose appears to be a promising nutritional supplement that may be an option for treating and preventing urinary tract infections, especially in people who have frequent UTIs.

October 2019 Clinics in Surgery Article Entitled “Oral D-Mannose in the Prevention and Treatment of Recurrent Urinary Tract Infections”

Authors: Porru D, Regina C , Fiorello N , Gardella B , Spinillo A and Jallous H

Summary: professional medical review of 13 clinical trials on D-Mannose showed that Several alternatives to antibiotics exist which are currently being explored. Our review allowed us to record that d mannose helps to prolong the recurrence-free interval, and therefore reduce the prolonged or cyclical use of antibiotics.”

June 2018 Pilot Study Entitled “Recurrent Bacterial Symptomatic Cystitis: A Pilot Study on a New Natural Option for Treatment”

Authors: Populo and Nelli

Summary: A study of 85 subjects with UTIs showed that this therapeutic approach combining D-Mannose with Salicin (acute treatment) and Lactobacillus acidophilus La-14 (maintaining treatment) seems to be effective in symptomatic bacterial UTIs.

May 2018 UK National Institute for Health and Care Excellence (NICE) Recommends D-Mannose

Summary: Trimethoprim and nitrofurantoin remain the first-line antibiotics of choice in all groups, except pregnant women. Pivmecillinam and fosfomycin are recommended as second-line choices for non-pregnant women who do not improve after 48 h.

For women with recurrent UTIs, the NICE guidance now suggests that clinicians consider recommending D-mannose (a sugar, found naturally in many fruits, available in powder form), and vaginal estrogen (for postmenopausal women) before considering single-dose antibiotic prophylaxis.

D-Mannose Supported By NICE

March 2018 Cleveland Clinic Article Entitled “The Truth About UTIs In Older Adults”

Author: Dr. Howard Goldman, MD

Summary: D-Mannose is a relatively new supplement that is being studied for its potential ability to prevent UTIs while causing few side effects. According to Dr. Goldman, D-Mannose sticks to the receptors in the bladder that would normally attract E. coli, the most common bacteria that causes UTIs. By sticking to these receptors, D-Mannose helps prevent E. coli from staying in the bladder, which may help reduce the risk of UTIs. D-Mannose works similarly in the bowels and is thought to prevent pathologic bacteria from colonizing the gastrointestinal tract, which is where the bacteria that cause UTIs in women may originate.

September 2017 Cell and BioScience article published by the National Institutes of Health (NIH) entitled “A good sugar, d-mannose, suppresses autoimmune diabetes”

Authors: Yun-Bo Shi and Deling Yin

Summary: In sum, the studies by Dr. Chen and his colleagues have discovered that d-mannose is a “healthy/good” monosaccharide and suggest that this unique sugar could be a safe dietary supplement to promote immune tolerance and to treat/prevent human diseases associated with autoimmunity and allergy.

April 2016 Paper in Comprehensive Reviews of Food Science and Food Safety Describing D-Mannose: “Properties, Production, and Applications: An Overview”

Authors: Xing Hu, Yaning Shi, Peng Zhang, Ming Miao, Tao Zhang, and Bo Jiang

Summary: This review of literature has revealed that d-mannose, as a highly potential functional and valuable ingredient, exhibits relatively impressive biological functions of great interest in the cosmetic, pharmaceutical, and food industries. The use of chemical methods in the production of d-mannose has the advantages of applying rapid and convenient processes, but some consumers do not agree with the production by chemical methods. Thus, with ongoing efforts in research and development, the biotransformation approach to d-mannose production with enzymes has gradually gained increasing interest and has become the most promising method.

Properties and Benefits of D-Mannose Based on Research in China

February 2014 PubMed/NIH Report Entitled “D-Mannose: A Promising Support For Acute Urinary Tract Infections In Women. A Pilot Study”

Author: Department of Gynecological Obstetrics and Urologic Sciences, University Sapienza of Rome, Rome, Italy.

Summary: D-mannose: a promising support for acute urinary tract infections in women. 45 women evaluated over a 15-month period. D-mannose had a significant positive effect on resolving UTI’s and improving patients’ quality of life. As a preventative administered for 6 months, it also showed promising results.

October 2018 Article Published in Nature Reviews Urology entitled “Nonantibiotic Prevention and Management of Recurrent Urinary Tract Infection”

Authors: Neha Sirha, Anna Goodman, Rhana Zakri, Arun Sahai, Sachin Malde

Summary: Results suggest that D-mannose could be an alternative to antibiotics in treating uncomplicated UTI in women and reduces the risk of recurrence. The evidence shows that D-mannose is well tolerated, but larger randomized studies are required to further validate its use.

February 2014 Article – Published By The NIH Entitled “D-mannose Powder for Prophylaxis of Recurrent Urinary Tract Infections in Women: A Randomized Clinical Trial”

Authors: Bojana Kranjcec, Dino Papes, Silvio Altarac

Summary: In a clinical trial assessing 308 women with recurrent urinary tract infections, results for those taking D-mannose powder were equal to the results in the Nitrofurantoin group in significantly reducing the risk of recurrent UTI. More studies will be needed to validate the results of this study, but initial findings show that D-mannose may be useful for UTI prevention.