Abstract
Urinary tract infections (UTIs) are very frequent in women and can be caused by a range of pathogens. High recurrence rates and increasing antibiotic resistance of uropathogens make UTIs a severe public health problem. d-mannose is a monosaccharide that can inhibit bacterial adhesion to the urothelium after oral intake. Several clinical studies have shown the efficacy of d-mannose in the prevention of recurrent UTIs; these also provided limited evidence for the efficacy of d-mannose in acute therapy. A recent prospective, non-interventional study in female patients with acute cystitis reported good success rates for treatment with d-mannose. Here, we present data from a post hoc analysis of this study to compare the cure rate of d-mannose monotherapy with that of antibiotics. The results show that d-mannose is a promising alternative to antibiotics in the treatment of acute uncomplicated UTIs in women.
Highlights
Adhesion of pathogens to the urothelial cells prevents their removal or washing off, and is their first step in colonizing the urinary bladder
The results show that D-mannose is a promising alternative to antibiotics in the treatment of acute uncomplicated Urinary tract infections (UTIs) in women
Our post hoc analysis shows that patients using D-mannose as monotherapy in AUC achieved very good clinical cure rates, similar to those achieved by patients receiving antibiotic treatments
Summary
Adhesion of pathogens to the urothelial cells prevents their removal or washing off, and is their first step in colonizing the urinary bladder. FimH enables the bacteria to bind onto bladder epithelial cells by attaching to uroplakin 1a, which consists of glycosylated proteins with mannose molecules as terminal units (Figure 1A) [20,21] Since it has been shown in UTI mouse models that FimH is critical for the pathogenesis of E. coli in AUC and is conserved in various E. coli strains [22], this adhesin is considered to be a good target for therapeutic interventions [23]. The acute cystitis symptom score (ACSS) is derived from a diagnostic questionnaire that measures patient-reported outcomes in women with AUC, and assesses the symptoms and their impact on the quality of life [29]. It has been clinically validated in several languages, including German and English Six of these seven events occurred in combination with an antibiotic, and one (flatulence) together with other therapeutic measures [42]
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