In the 2 most comprehensive systematic reviews, heterogeneity was handled differently, leading to an I2 of 65% in one and 43% in the other. Therefore, at present, there is no evidence to suggest that cranberry juice or other cranberry products are effective for treatment of UTI. (20) and Wang et al. (20) and Wang et al. Drinking cranberry juice is just one of the myths about preventing and treating urinary tract infections (UTIs). A cornerstone of prevention of UTI recurrence has been the use of low-dose once-daily or post-coital antimicrobials; however, much interest has surrounded non-antimicrobial-based approaches undergoing investigation such as use of probiotics, vaccines, oligosaccharide inhibitors of bacterial adherence and colonization, and bacterial interference with immunoreactive extracts of Escherichia coli. (20) also found a similar trend for a reduction in RR in the same group, it was not statistically significant (RR = 0.74; 95% CI: 0.42, 1.31). Cochrane Database Syst Rev. COVID-19 is an emerging, rapidly evolving situation. At present, there is no evidence that cranberry can be used to treat UTIs. A double-blind, placebo-controlled trial, Spinal-injured neuropathic bladder antisepsis (SINBA) trial, Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder, Cranberry for UTI prevention in residents of long term care facilities (PACS) [Internet], Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study, Cranberry juice for the prevention of recurrent urinary tract infections: a randomized controlled trial in children, Efficacy of cranberry juice for the prevention of urinary tract infections in pregnancy [abstract], Cranberry juice for the prevention of recurrences of urinary tract infections in children: a randomized placebo-controlled trial, Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial, A randomized, double blind, controlled, dose dependent clinical trial to evaluate the efficacy of a proanthocyanidin standardized whole cranberry (Vaccinium macrocarpon) powder on infections of the urinary tract, A randomised double-blind placebo controlled trial to determine the effect of cranberry juice on decreasing the incidence of urinary symptoms and urinary tract infections in patients undergoing radiotherapy for cancer of the bladder or cervix, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Complicated urinary tract infections: developing drugs for treatment. CENTRAL, Cochrane Central Registry of Controlled Trials; PAC, proanthocyanidin; RCT, randomized controlled trial; rUTI, recurrent urinary tract infection; UTI, urinary tract infection. Table 2 summarizes studies and populations that were included in 3 Cochrane systematic reviews (20, 21, 28), Wang et al. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. In terms of efficacy assessment of the cranberry on UTI prevention, population definition is a key methodological element for consideration in performing a meta-analysis. Terms: (1) beverage, fruit beverage, fruit drink, fruit juice, cranberry, To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations, RCTs and quasi-RCTs; comparison of cranberry products vs. placebo, no intervention, or other intervention; excluded studies on treatment of UTIs; excluded studies on UTIs not caused by bacterial infection; outcomes: incidence of UTIs, Cranberry juice is less effective than previously indicated; cranberry juice cannot currently be recommended for the prevention of UTIs. (19) and Beerepoot et al. Maki KC, Kaspar KL, Khoo C, et al. And lab studies have found chemicals called proanthocyanidins in cranberries can stop E. coli (the bug that causes most urinary infections) from sticking to the lining of the urinary tract. Author disclosures: DJ Liska, HJ Kern, and KC Maki, no conflicts of interest. The current proposed mechanism is plausible and supported by the results of in vitro and preclinical studies. Furthermore, 25–35% of women who experience a UTI will have ≥1 recurrent UTI (rUTI) episode within the subsequent year (4, 5). The discussion section in both systematic reviews explored potential reasons that findings by Barbosa-Cesnik et al. There is, however, some evidence that a daily 'dose' of cranberry juice may reduce the risk of recurrent urinary tract infection. This significant reduction was not seen when UTIs were confirmed by urine culture (19.8% versus 24.0%; very low quality evidence). proanthocyanidins). Jepson et al. Withdrawal rates have been quite high (up to 55%), suggesting that these products may not be acceptable over long periods. We’ll separate UTI fact from fiction. At present, there is no evidence that cranberry can be used to treat UTIs. Clinically, UTIs can be categorized as complicated, which occur under conditions of bladder dysfunction and during types of medical treatments such as chemotherapy, and uncomplicated (2). What does the research tell us? These studies also do not show any apparent harm from such products, though the risks seen in humans may only be evident with long-term use. (20) did not exclude this study, mainly because of its large sample size, whereas Wang et al. Because dried cranberries may contain a different spectrum of polyphenolics than juice, consuming berries may or may not be more beneficial than juice in decreasing the incidence of UTIs in susceptible women. How to manage rUTIs without inducing multidrug resistance in women is an important consideration in clinical practice (6, 7, 9). “Many studies of cranberry products have been conducted over several decades with conflicting evidence of its utility for UTI prevention”, Dr Manisha Juthani-Mehta said. (47) were different from other studies, including a lower threshold for UTI diagnosis (103 cfu/mL compared to a common threshold: 105 cfu/mL). 1 However, 2 recent randomized studies, not included in the Cochrane review, found that women taking cranberry juice have fewer symptomatic UTIs. Cranberries for preventing urinary tract infections. One of the most widely held beliefs about UTIs is that drinking cranberry juice (or taking cranberry supplements) can prevent and get rid of them. (20), only 1 included women with rUTIs [because this was only a letter without additional data, it was excluded from Jepson et al. There has long been an interest in the use of cranberry, usually as a juice, to prevent and treat urinary tract infections (UTI). As the authors point out, although their previous review of 11 studies found some evidence that cranberry juice may reduce UTIs, the addition of 14 new studies suggest cranberry juice is less effective than previously indicated. Generalization of research evidence from high-risk populations to low-risk groups should be avoided to ensure the integrity of guidelines and reduce unwanted harm on patients, which is yet to be enhanced (52). There is evidence to support the use of cranberry to prevent UTI in some populations but none to support its use as a treatment. Overall, however, the RR estimates for rUTI prevention in this subgroup of women are similar across the systematic reviews. study (47). | Urinary tract infections (UTIs)6 are the second most common infection of any organ system and the most common urological disease in the United States, with a total annual cost of >$3.5 billion (1). (27). Meta-analyses have established that recurrence rates over 1 year are reduced approximately 35% in young to middle-aged women. In fact, as Susan Scutti reports for CNN, a 2012 review of 24 studies totalling 4,473 participants found little evidence of positive effects, and concluded that cranberry juice "cannot be recommended for the prevention of UTIs". Although results from a number of clinical studies have been published supporting its benefits, the efficacy of the cranberry on prevention of rUTIs remains controversial, in part because of conflicting conclusions from meta-analyses. It is uncertain whether it is effective in other susceptible groups. Thus far, there has been no concrete evidence in support of the use of cranberry juice for eliminating the problems linked to urinary tract infections. As observed in our review, the variability of participants in Jepson et al. Evidence-based information on cranberry urinary health from hundreds of trustworthy sources for health and social care. (27). Evidence summary. (47), in the analysis of the use of cranberry to treat women with rUTIs (Supplemental Table 1). This mini-review examined the evidence available using a simple search on an internet-based resource designed to make evidence readily available to practitioners in the South Eastern NHS regions of the UK. Similarly, outcome measures differed in the diagnosis of a UTI (e.g., lower threshold of bacteria for UTI diagnosis) and varied in the timing of UTI assessments (e.g., 6- vs. 12-mo follow-up). Consumption of cranberry juice to prevent UTIs is actually very well-studied. However, in light of the heterogeneity of clinical study designs and the lack of consensus regarding the dosage regimen and formulation to use, cranberry products cannot be recommended for the prophylaxis of recurrent UTIs at this time. Free Online Library: Evidence based practice review: cranberry for urinary tract infection prophylaxis in children at risk of recurrent UTI. The 4 studies contributed the majority (53.7%) of total weight to the total RR estimate in Jepson et al., 2012 (20). Heterogeneity and Barbosa-Cesnik 2011 study (32) in Jepson 2012 (23) & Wang 2012 (22) Systematic reviews, Oxford University Press is a department of the University of Oxford. Differences in selection of studies in 5 different analyses1. doi: 10.1002/14651858.CD001321.pub5. Clipboard, Search History, and several other advanced features are temporarily unavailable. A meta-analysis with focus on this most relevant population is warranted. From the Kontiokari et al. (19) included 5 studies in common with Jepson and Craig (21) for overall risk estimates, only 2 of which were conducted in women with rUTIs. To our knowledge, this is the first assessment of evidence-based systematic reviews on cranberries and the prevention of rUTIs, with evaluation of methodological discrepancies between the high profile meta-analyses. 2020;6(1):64. doi: 10.1186/s43094-020-00086-2. This evidence review covers the prevention of UTI in women (including 5 pregnant women), men and children with recurrent UTI, who do not have a catheter. The effectiveness of cranberry products to reduce urinary tract infections in females: a literature review, A systematic review of the evidence for cranberries and blueberries in UTI prevention, Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a Markov chain Monte Carlo model, Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials, Cranberries for preventing urinary tract infections, Reduction of bacteriuria and pyuria after ingestion of cranberry juice, Reduction of bacteriuria and pyuria using cranberry juice [letter], Efficacy of cranberry in prevention of urinary tract infection in a susceptible pediatric population, Cranberry concentrate: UTI prophylaxis [letter], Effect of cranberry juice on bacteriuria in children with neurogenic bladder receiving intermittent catheterization, Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women, A doubleblind, randomized, placebo-controlled trial of cranberry supplements in multiple sclerosis, A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women, Evaluation of cranberry supplement for reduction of urinary tract infections in individuals with neurogenic bladders secondary to spinal cord injury. 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