But consider the … (19) analyses (Table 2). #### What you need to know Recurrent urinary tract infection in women is a common problem. This is evident from the studies conducted on the subject matter in 2012 and 2013. Please enable it to take advantage of the complete set of features! The thing is, when you look at all the scientific research, the evidence cranberry products work just doesn’t stack up. Some studies have found that drinking cranberry juice or taking cranberry pills can prevent UTIs, especially in women who are at risk for these infections. 2012 Oct 17;10(10):CD001321. Wang et al. (47) were different from other studies, including a lower threshold for UTI diagnosis (103 cfu/mL compared to a common threshold: 105 cfu/mL). Cranberry and cystitis, what’s the story? Just remember that even natural juices can contain a lot of sugar, so be mindful of moderating your consumption. What does the research tell us? Of these 9 reviews, 5 were systematic reviews with meta-analyses: 3 were from the Cochrane Collaboration (20, 21, 28), the latest of which was published in 2012 as an update of previous publications; 2 others were by Wang et al. Lower 6 UTI, acute pyelonephritis, and catheter-associated UTI are covered in separate evidence 7 reviews. Meta-analyses have established that recurrence rates over 1 year are reduced approximately 35% in young to middle-aged women. However, these trials suffer from a number of limitations. The safety of cranberries is considered to be excellent. Specifically, a meta-analysis by Wang and colleagues published in 2012 concluded that “cranberry products were associated with protective effects against UTIs (RR: 0.62; 95% CI: 0.49, 0.80), particularly for women with rUTIs (RR: 0.53; 95% CI: 0.33, 0.83)” (19). (19) noted that the inclusion of the Barbosa-Cesnik et al. 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. 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. 2013;131(5):363. doi: 10.1590/1516-3180.20131315T1. Despite these guidelines toward the best evidence syntheses, the presence of substantial heterogeneity in systematic reviews has made it a challenge for health care professionals and policymakers to apply such nonspecific findings (50). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. review (20) when subjects with cUTIs and uncomplicated UTIs were combined in the overall risk estimates. Recurrences requiring intervention are usually defined as two or more episodes over 6 months or three or more episodes over 1 year (this definition applies only to young women with acute uncomplicated UTIs). Early reviews on the cranberry and UTIs have noted that efficacy was observed in clinical trials assessing prevention of rUTIs in generally healthy women, but not against cUTIs or as a treatment for UTIs (11, 13). (27) (not shown) only assessed cranberry compared with placebo in women with rUTIs and reported the RR to be 0.53 (95% CI: 0.33, 0.83) Although Jepson et al. Overall, 21 studies were identified across all analyses; however, each analysis included only a subset of 2–13 studies. The … Cranberries contain 2 compounds with antiadherence properties that prevent fimbriated Escherichia coli from adhering to uroepithelial cells in the urinary tract. These observations have indicated that cranberries may provide an option for prophylaxis in certain populations. Cranberry products in a variety of formulations have also undergone extensive evaluation over several decades in the management of UTIs. The guidelines state that there is very little evidence to suggest that drinking cranberry juice will reduce the risk of developing UTIs, and 'no evidence' that it will cure cystitis. There is, however, some evidence that a daily 'dose' of cranberry juice may reduce the risk of recurrent urinary tract infection. Drinking cranberry juice is just one of the myths about preventing and treating urinary tract infections (UTIs). NA, not applicable (studies were published after the search date); UTI, urinary tract infection. Authors provided details on search strategy but not inclusion/exclusion criteria and results of the search strategy. The overall conclusion on totality of evidence made by Jepson et al. RR (cranberry vs. placebo/control) by subgroup in 3 meta-analysis reviews1. 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. Specifically, among women with rUTIs, RR for cranberry compared with placebo/control on rUTIs was reported to be 0.53 (95% CI: 0.33, 0.83) by Wang et al. J Gen Intern Med. 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. (47), in the analysis of the use of cranberry to treat women with rUTIs (Supplemental Table 1). Differences in subgroup contributions to overall relative risk estimates. A lot of people swear cranberry works for them. Cranberry is nearly as effective as low-dose antibiotics for urinary tract infection (UTI) prevention in women and children and does not cause antibiotic resistance. Scientifically, there is mixed evidence on the relation between cranberry juice and the prevention of UTIs, and while some have called cranberry’s health benefits merely a ‘myth’, others have explored the scientific properties of cranberry to explain why or why not cranberry juice helps with UTIs. (19) analyses had the same research questions, similar overall inclusion criteria for study selection, and comparable statistical models (Table 3). 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. “There is some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period… the large number of dropouts/withdrawals indicates that cranberry juice may not be acceptable over long periods of time… not clear what is the optimum dosage or method of administration… further properly designed studies with relevant outcomes are needed.” Step 2: … The current proposed mechanism is plausible and supported by the results of in vitro and preclinical studies. (20) and Wang et al. Antibiotics, which are commonly prescribed for UTIs, are efficacious for treatment and have also been used for prophylaxis of rUTIs (2, 3, 6). We’ll separate UTI fact from fiction. It is uncertain whether it is effective in other susceptible groups. (19) report also addressed separate populations in their conclusions, noting that cranberry products appear to be more effective for prevention of rUTIs in women. Because women with recurrent UTIs are the group to whom most recommendations regarding cranberry consumption is directed, inclusion of other groups in the efficacy assessment could influence clinical practice quality. Foda MM, Middlebrook PF, Gatfield CT, Potvin G, Wells G, Schillinger JF. Does include noncranberry and non–UTI-related terms. Urol Clin North Am. There is no universally accepted definition, but most clinicians would classify recurrent UTI as being two episodes of infection in six months, or three episodes in one year.1 The annual incidence of a single UTI is 30 per 1000 women,2 with 44% experiencing recurrence within 12 months.3 #### When … DeAnn J Liska, Hua J Kern, Kevin C Maki, Cranberries and Urinary Tract Infections: How Can the Same Evidence Lead to Conflicting Advice?, Advances in Nutrition, Volume 7, Issue 3, May 2016, Pages 498–506, https://doi.org/10.3945/an.115.011197. The role of cognitive functions in the diagnosis of bipolar disorder: A machine learning model. See specific reports for full list of search terms. Epub 2020 Jul 7. A British January 2008 Cochrane Database Systematic Review of 10 studies reported that cranberry had value in preventing UTIs in women with a history of recurrent UTI 6. 2020 Oct;20(4):3399-3406. doi: 10.3892/etm.2020.8970. Furthermore, 25–35% of women who experience a UTI will have ≥1 recurrent UTI (rUTI) episode within the subsequent year (4, 5). Beerepoot MAJ, Geerlings SE, van Haarst EP, Mensing van Charante N, ter Riet G. Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I, Lipsitz LA. Augmentation with Atypical Antipsychotics for Treatment-Resistant Depression. Aydin A, Ahmed K, Zaman I, Khan MS, Dasgupta P. Jernberg C, Löfmark S, Edlund C, Jansson JK. 2020 Apr 30;11:504. doi: 10.3389/fphar.2020.00504. Approximately 50% of the general healthy female population will experience ≥1 UTI during their lifetime (3, 4). Evidence was not conclusive in other groups. (20) did not exclude this study, mainly because of its large sample size, whereas Wang et al. Results from a number of published clinical studies have supported this benefit; however, meta-analyses on cranberry and UTI prevention have reported conflicting conclusions. The comparisons on methodologies included inclusion/exclusion criteria, extracted data, and statistical methods. A literature search was conducted to identify eligible systematic reviews and meta-analyses to be included in this assessment (see Supplemental Data). (19) included similarly diverse populations (except radiotherapy patients), the evidence was weighted relatively equally across the populations as follows: cUTIs (40.9% of the total weight), women with rUTIs (32.3% of the total weight), and other populations including children, elderly, and pregnant women (26.8% of the total weight) (Table 4). Recent scientific studies show it’s likely that cranberry tablets reduce the instances of UTIs. Despite significant heterogeneity with inclusion of the Barbosa-Cesnik et al. There was only evidence assessing the efficacy and safety of cranberry products for preventing asymptomatic bacteriuria in healthy pregnant women. Litwin MS, Saigal CS, Yano EM, Avila C, Geschwind SA, Hanley JM, Joyce GF, Madison R, Pace J, Polich SM, et al. The outcome was incidence of UTIs at 12 mo (21). McMurdo ME, Bissett LY, Price RJ, Phillips G, Crombie IK. 2004;(2):CD001321. | Thus, identification of successful nonantibiotic strategies for the prevention of rUTIs in generally healthy women is of high importance. Curr Pharm Biotechnol. The literature search identified 83 records (Figure 1), and 9 systematic reviews met the inclusion criteria for the evidence assessment (Table 1). Therefore, at present, there is no evidence to suggest that cranberry juice or other cranberry products are effective for treatment of UTI. Repetitive use of antibiotics, however, is recognized as a factor in the development of multidrug resistance bacteria and recently is reported to affect the human commensal microbiota (7, 8). Inconsistency in meta-analysis methodologies, including clinical (i.e., participants, outcome, and intervention) and methodological heterogeneity (i.e., trial design and execution including i… However, there is not much evidence to support that a glass of cranberry juice a day will keep the UTI away. 13. A lower cutoff used to define UTI may increase the sensitivity but decrease the specificity of a test, which may bias the overall RR of treatment compared with the control/placebo toward a null effect. It is uncertain whether it is effective in other susceptible groups. The idea is they can stop a UTI before it really gets started or treat the symptoms once you have it. Cranberry capsules lowered the risk of UTIs by 50%. Traditionally, the cranberry has been used to prevent rUTIs among generally healthy women. study (47) introduced substantial heterogeneity (I2 = 65% and 59%, respectively). Cranberries for preventing urinary tract infections. Reasons for this nonsignificant RR in Jepson et al. There is evidence to support the use of cranberry to prevent UTI in some populations but none to support its use as a treatment. The discussion section in both systematic reviews explored potential reasons that findings by Barbosa-Cesnik et al. The influences of specific studies on the overall conclusions were also explored. 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. study (34) differed at the 6- and 12-mo follow-up, such inconsistency in the timing of outcome measurements could influence the strength of the summary RR estimates in the meta-analyses. Still, there’s no evidence to support cranberry juice doing the same 16 17. (20), Jepson and Craig (21), and Wang et al. uropathogenic E. coli) to the uroepithelium, thus impairing colonization and subsequent infection. US Department of Health and Human Services, FDA, Center for Drug Evaluation and Research. Urology 2001;57:407-13. Cranberry Consumption Against Urinary Tract Infections: Clinical Stateof- the-Art and Future Perspectives. Molecules. A meta-analysis with focus on this most relevant population is warranted. They also noted that th… Cranberries for preventing urinary tract infections. From the Kontiokari et al. In one analysis, populations with pathological/physiological conditions contributed 75.6% of the total weight to the summary risk estimate (RR: 0.86; 95% CI: 0.71, 1.04); another weighted the evidence relatively equally across UTI populations (RR: 0.62; 95% CI: 0.49, 0.80); and a third included only women with recurrent UTIs (RR: 0.53; 95% CI: 0.33, 0.83). Standard checklists, including Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), have been developed to evaluate the evidence quality that is linked to clinical recommendations, clarify meta-analysis methodology, and minimize possible bias (28, 50). (19) reported substantial heterogeneity with inclusion of 1 specific study by Barbosa-Cesnik et al. Arch Intern Med 2012;172:988–96. It is pretty clear from this research that cranberry is not an effective treatment for UTI in humans.8There is, however, less clarity regarding the efficacy of cranberry products in preventing UTI. All authors read and approved the final manuscript. 2020 Feb 17;25(4):881. doi: 10.3390/molecules25040881. However it does not prove that cranberry juice is an effective treatment for urinary tract infections. 2005 Apr;11(2):305-9 Approximately 1 dozen clinical trials have been performed testing the effects of cranberries on the urinary tract. Front Pharmacol. Cochrane Database Syst Rev 2012;10:CD001321. These differences were due to the selection of outcome measures at different time points (i.e., at 6- vs. 12-mo follow-up). The FDA would accept the following wording for the qualified claim for juices: “Limited and inconsistent scientific evidence shows that by consuming one serving (8 oz) each day of a cranberry juice beverage, healthy women who have had a urinary tract infection (UTI) may reduce their risk of recurrent UTI.” In addition, recurrent UTIs are also common, occurring in up to one-third of women after first-episode UTIs. Cranberry juice and cystitis have been traditionally linked, but is it all a big myth or is there some convincing evidence behind it all? Why Does Cranberry Juice Help UTI? This further points out that the biology and clinical relevance should be considered when identifying populations for assessment. Specifically, due to the common occurrence of rUTIs, recommendations to use diet and lifestyle approaches before prophylactic antibiotics are advocated (6, 7). Evidence-Based Answer. (19) and Beerepoot et al. It is notable that the Jepson et al. Cranberry juice and cystitis have been traditionally linked, but is it all a big myth or is there some convincing evidence behind it all?. Jepson et al. (20), only 1 included women with rUTIs [because this was only a letter without additional data, it was excluded from Jepson et al. Proanthrocyanidins have anti-adhesive properties that make it harder for bacteria to stick to the walls and tissue within the urinary tract. A prospective, double-blinded, placebo-controlled, crossover study, Effect of cranberry extract on bacteriuria and pyuria in persons with neurogenic bladder secondary to spinal cord injury, Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in hospital? The isolation of the component(s) of cranberry with this activity has been a daunting task, considering the hundreds of compounds found in the fruit and its juice derivatives. Cranberries and UTIs have been evaluated in evidence-based systematic reviews and meta-analyses, but instead of providing clarity on the efficacy of the cranberry for prevention of rUTIs, these systematic reviews have resulted in conflicting conclusions. (27). Both RCTs found that cranberry (as juice or capsule) significantly reduced the rate of UTI in sexually active women. Both cranberry juice and cranberry tablets contain antioxidant-rich polyphenols 18. Commentary on: Jepson RG, Williams G, Craig JC. -, J Altern Complement Med. | At present, there is no evidence that cranberry can be used to treat UTIs. Only 2 studies were included in all analyses (Table 2), with another 5 studies included in both the Jepson et al. There is some evidence from four good quality RCTs that cranberry juice may decrease the number of symptomatic UTIs over a 12‐month period, particularly in women with recurrent UTIs. When divergent conclusions are drawn from meta-analyses of a similar pool of original trials, it becomes a challenge for clinicians and policymakers to make the most appropriate or relevant recommendations to the public and clinicians. (20) and 0.44 (95% CI: 0.21, 0.93) by both Wang et al. As observed in our review, the variability of participants in Jepson et al. Not all cranberry products contain enough active proanthocyanidins (PACs) for clinical efficacy. Rădulescu D, David C, Turcu FL, Spătaru DM, Popescu P, Văcăroiu IA. Further evidence suggests that the mechanism involves proanthrocyanidins, a type of polyphenol compound found in cranberries. Surprisingly, studies included in these 2 meta-analyses were substantially different. Hess MJ, Hess PR, Sullivan MR, Nee M, Yalla SV. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2018;19(13):1049-1063. doi: 10.2174/1389201020666181206104129. There is still room for additional research to be carried out in this area before we can definitively state that there are benefits to be derived. Gupta A, Dwivedi M, Mahdi AA, Nagana Gowda GA, Khetrapal CL, Bhandari M. Blumberg JB, Camesano TA, Cassidy A, Kris-Etherton P, Howell A, Manach C, Ostertag LM, Sies H, Skulas-Ray A, Vita JA. The main reporting used in the analysis was without Barbosa-Cesnik et al. “Many studies of cranberry products have been conducted over several decades with conflicting evidence of its utility for UTI prevention”, Dr Manisha … UTI, urinary tract infection. The methodological challenges discussed in the present review are consistent with literature in a broader context of clinical practice guidelines. Ferrara P, Romaniello L, Vitelli O, Gatto A, Serva M, Cataldi L. Salo J, Uhari M, Helminen M, Korppi M, Nieminen T, Pokka T, Kontiokari T. Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B. Sengupta K, Alluri KV, Golakoti T, Gottumukkala GV, Raavi J, Kotchrlakota L, Sigalan SC, Dey D, Ghosh S, Chatterjee A. Cowan CC, Hutchison C, Cole T, Barry SJ, Paul J, Reed NS, Russell JM. Cranberry products used for 6 to 12 months did significantly reduce the incidence of UTI in non‑pregnant women with a previous history of UTI compared with placebo or no treatment (20.7% versus 26.5%; NNT 17 [range 9 to 68]; very low quality evidence). (47) and 1 without. 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. A Cochrane review found only a small number of poor-quality trials, providing insufficient support to recommend cranberry juice to prevent UTI. 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. (19) reported a reduction in heterogeneity to I2 = 43% when the study was excluded. (19) further conducted a sensitivity analysis that identified the study by Barbosa-Cesnik et al. Terms summarized for comparison of scope or search. 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). At this point, further research is warranted, but any recommendation for the use of cranberry supplements should be accompanied by … Cranberries have historically been associated with urinary tract health, particularly among women with rUTIs (10–12). In the cranberry treatment group, 19% of patients developed a UTI, compared with 38% of the placebo group. Sao Paulo Med J. (19) and Beerepoot et al. Futur J Pharm Sci. Cochrane Database Syst Rev. Evidence-based information on cranberry juice and urine infections from hundreds of trustworthy sources for health and social care. 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