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D mannose for prevention and treatment of urinary tract infection (UTI)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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D-mannose for prevention and treatment of UTIs

  • D-mannose is a simple sugar, a monosaccharide extracted from larch rod, closely related to glucose
    • several fruits and vegetables contain D-mannose, including:
      • cranberries (and cranberry juice)
      • apples
      • oranges
      • peaches
      • broccoli
      • green beans
    • D-mannose is rapidly absorbed and in about 30 minutes reaches the peripheral organs, then is excreted by the urinary tract
    • D-mannose cannot be transformed into glycogen and, therefore, is not stored in the body
    • long-term use of D-mannose, in concentrations up to 20%, has not shown any side effect on human metabolism (1)

  • the process of bacterial adhesion on the cell surface is a crucial factor for the onset of most infections
    • occurs because specific lectins on bacterial wall are able to bind molecules such as D-mannose and L-fucose distributed on the human cell surface
      • the bladder wall is coated with various mannosilate proteins, such as Tamm-Horsfall protein (THP) that interfere directly with the adhesion of bacteria on the mucosa
        • THP may fasten to E. coli with a specific bond, which may be inhibited by exogenous D-mannose
        • by inhibiting the adhesion of bacteria to the urothelium, D-mannose mimics urothelial barrier function
        • by binding free D-mannose in the urine rather than proteins on the vesical cell's surface, bacteria are trapped in the urinary flow and consequently eliminated by the urinary tract

  • NICE was aware of the mechanism of action of D-mannose, which is also in cranberry products
    • noted evidence suggesting that D-mannose was effective in reducing the risk of recurrent UTI in non-pregnant women, and noted the low NNT of 3 (range 2 to 3) over 6 months, compared with no treatment (2)
    • however, this was based on 1 small RCT (3)
      • D-mannose (200 ml of 1% solution once daily in the evening) used for up to 6 months significantly reduced the risk of recurrent infection in non-pregnant women compared with no treatment (14.6% versus 60.8%, NNT 3 [range 2 to 3]; high-quality evidence)
        • based on 1 RCT in non-pregnant women presenting with a current UTI and a history of recurrent UTI
    • a study by Domennici et al suggest that D-mannose can be an effective aid in acute cystitis management and also a successful prophylactic agent in a selected population (4)

  • NICE made a recommendation that some women who are not pregnant may wish to try D-mannose, as a self-care treatment, noting the sugar content of this product which should be considered

A randomised controlled trial (RCT) (n=598, ≥2 UTIs in previous 6 months, or ≥3 in 12 months) found daily d-mannose for 6 months did not reduce the proportion of women with recurrent UTI in primary care who experienced a subsequent clinically suspected UTI vs placebo (51.0% vs 55.7%, respectively; P=0.26) (5)

  • study also found that d-mannose supplementation did not improve other important secondary outcomes, including the number of days of at least moderate symptoms of UTI, time to next consultation for a clinically suspected UTI, number of microbiologically proven UTIs, number of prescribed antibiotic courses for suspected UTI, or hospitalisations or serious adverse events


  1. Rosen DA et al. Molecular variations in Klebsiella pneumonia and Escherichia coli FimH affect function and pathogenesis in the urinary tract. Infect Immun 2008; 76: 3346-3356
  2. NICE (October 2018). Urinary tract infection (recurrent): antimicrobial prescribing
  3. Kranjcec B, Papes D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial.World J Urol. 2014 Feb;32(1):79-84. doi: 10.1007/s00345-013-1091-6. Epub 2013 Apr 30.
  4. Domenici L et al. D-mannose: a promising support for acute urinary tract infections in women. A pilot study. Eur Rev Med Pharmacol Sci. 2016 Jul;20(13):2920-5.
  5. Hayward G, Mort S, Hay AD, et al. d-Mannose for Prevention of Recurrent Urinary Tract Infection Among Women: A Randomized Clinical Trial. JAMA Intern Med. Published online April 08, 2024. doi:10.1001/jamainternmed.2024.0264

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