Effects of a New Combination of Cranberry Extracts, D-Mannose and GAGs for the Management of Uncomplicated Urinary Tract Infection

OBJECTIVE: Several studies have investigated the role of cranberry extract and D-mannose in the prevention of recurrent urinary tract infections (UTIs). The aim of this preliminary study was to test whether the use of a new dietary supplement (UROIAL TM sachets) containing cranberry extracts (S&R PACs), D-mannose, hyaluronic Acid and Glucosamine Chondroitin may reduce the incidence of episodes of cystitis and improve urinary symptoms. METHODS: In this prospective comparative study, 40 women with an acute diagnosis of cystitis received a single sachet of Fosfomycin Tromethamine (3gr). The subjects were then randomly assigned to two groups: Group A: 20 women were given UROIAL TM , 2 sachet per day during the first 7 days, then 1 sachet per day for two weeks; Group B: 20 women did not receive any treatment to serve as a control group. RESULTS: The results of the present study showed a complete remission of urinary symptoms in 37 women, a slight decrease in urinary symptoms was observed in 2 subjects, whereas 1 woman who stopped the treatment was considered a drop-out. Patients in Group A had a lower incidence of episodes of recurrent cystitis during treatment and follow-up; urine samples had significantly lower median bacterial load compared to baseline as well as a symptomatic relief was reported in treated subjects despite the control group. DISCUSSION: Several studies have investigated and demonstrated the role of cranberry extracts in the prevention of recurrent urinary tract infections (UTIs), on different selected subpopulations and even at increased risk of UTI. Even the use of D-mannose, a natural sugar has proven to have clinical benefit, although clinical data is limited. A randomized placebo-controlled non-blinded clinical trial has shown that a daily dose of 2 g d-mannose was superior to placebo in preventing UTI. Mannose receptors are found on uroepithelial cells lining the urinary tract they constitute the protective mucopolysaccharide layer of the bladder. The mechanism of action involves binding of the mannose receptors to E. coli pili, thus preventing both adhesion to and invasion of urothelial cells. The interaction between mannose molecules and E. coli bacteria can then be washed away with urine voiding. CONCLUSIONS: Our data indicate that the addition of GAGs (hyaluronic acid and chondroitin sulfate) to cranberry/D-Mannose containing products could represent a valid novel therapeutic approach for the treatment and/or prophylaxis of cystitis.