Conquy, S. [Cranberries for preventing urinary tract infections?]. Prog Urol 2006;16(4 Suppl FMC):3-4. View abstract. Heterogeneity was analyzed using a chi-squared test on N-1 degrees of freedom. An alpha value of 0.05 was used for statistical significance with the I 2 test [ 32]. I 2 values of 25%, 50% and 75% correspond to low, medium and high levels of heterogeneity, respectively. The rate of UTI recurrence was 21.3% (30/141) in the treatment group and 32.2% (46/143) in the control group. Our analysis of the data showed that probiotics did not have a statistically significant effect in reducing the rate of UTI recurrence (Risk Ratio (RR): 0.59 confidence interval (CI): 0.26, 1.33), Heterogeneity: Chi² = 6.63, df = 2 (p = 0.04); I² =70%, Test for overall effect: Z = 1.27 (p = 0.20) (Figure ​ (Figure2). 2). Although the forest plot demonstrated a trend towards benefit in the treatment arms, there was no statistically significant difference in the combined analysis. This finding will be further discussed in the discussion section.

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In patients with rUTIs, the current clinical approach for prophylaxis is a long-term, low-dose regimen of an antimicrobial agent, such as trimethoprim or nitrofurantoin [ 11]. Unfortunately, some bacteria have become resistant to the most frequently prescribed antibiotics which may result in UTI recurrence due to impaired clearance of said bacteria. This phenomenon has motivated the study of alternative non-antibiotic therapies, such as methenamine-hippurate, cranberry tablets, D-mannose, and probiotics, which are thought, in part, to counteract microbial resistance by reducing the need for antibiotic treatment [ 12]. Di Martino, P., Agniel, R., David, K., Templer, C., Gaillard, J. L., Denys, P., and Botto, H. Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial. World J Urol 2006;24(1):21-27. View abstract. Konowalchuk, J. and Speirs, J. I. Antiviral effect of commercial juices and beverages. Appl.Environ.Microbiol. 1978;35(6):1219-1220. View abstract.Williams G, Hahn D, Stephens JH, Craig JC, Hodson EM. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2023;4:CD001321.View abstract. Goodfriend, R. Reduction of bacteriuria and pyuria using cranberry juice. JAMA 8-24-1994;272(8):588-590. View abstract.

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Liu H , Howell AB , Zhang DJ , Khoo C. A randomized, double-blind, placebo-controlled pilot study to assess bacterial anti-adhesive activity in human urine following consumption of a cranberry supplement. Food Funct 2019;10(12):7645-52. View abstract. Tempera, G., Corsello, S., Genovese, C., Caruso, F. E., and Nicolosi, D. Inhibitory activity of cranberry extract on the bacterial adhesiveness in the urine of women: an ex-vivo study. Int J Immunopathol.Pharmacol. 2010;23(2):611-618. View abstract.The reviewers considered lag time as a potentially compromising variable in the results. In the Stapleton study, subjects were treated for acute UTI at visit 1 with standard therapy, given probiotics seven to 10 days after visit 1, and then reevaluated at 10 weeks [ 21]. It is unclear which antibiotic the authors deemed “standard therapy.” It was also unclear how long the subjects were treated for. If the antibiotic regimen was long enough to affect probiotic microbe viability, this may have prevented adequate colonization of the protective microbes in the urogenital tract. This is another variable in methodology that requires standardization across studies wishing to assess the efficacy of probiotics in treatment/prophylaxis of UTIs. Our impression is that the follow-up methodology of the Koradia study for follow-up was ideal as subjects were reevaluated on days 45, 90, 135 and end-of-study [ 22]. This time frame allows for antibiotics to effectively clear uropathogens while also allowing for probiotic colonization to take place, insofar as oral supplements are able to do so. Lynch, D. M. Cranberry for prevention of urinary tract infections. Am Fam.Physician 12-1-2004;70(11):2175-2177. View abstract. Avoid the Greenwashing Trap: How Food Companies Can Build Trust and Transparency in Regenerative Agriculture

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Ushijima K, Tsuruoka S, Tsuda H, Hasegawa G, Obi Y, Kaneda T, Takahashi M, Maekawa T, Sasaki T, Koshimizu TA, Fujimura A. Cranberry juice suppressed the diclofenac metabolism by human liver microsomes, but not in healthy human subjects. Br J Clin Pharmacol 2009;68(2):194-200. View abstract. Healthy bacteria are required to support both the digestive tract and the urogenital tract in women. For example, most urinary tract infections (UTIs), often referred to as cystitis, are caused by a species of bacteria called Escherichia coli ( E. coli), which generally live happily alongside the good bacteria in the gut and urogenital tract, but can sometimes grow and cause infection. During the review phase of our study, the authors noted novel literature on the deliberate establishment of asymptomatic bacteriuria with a particular strain of Escherichia coli having a significant effect in reducing the rate of reported UTIs in patients with incomplete bladder emptying. This intervention has been termed “bacterial interference,” in which the bladder is intentionally colonized with low virulence bacteria. Interestingly, RCTs that have evaluated this intervention as a strategy for UTI prophylaxis have found bladder instillation to be highly effective, particularly in patients with neurogenic bladder. In a literature review conducted by Falcou et al., researchers found that bladder interference with non-pathogenic strains of Escherichia coli (HU 2117 and 83972) was associated with statistically significant reductions in symptomatic urinary tract infections in patients with neurogenic bladder [ 43]. These findings suggest that bladder instillations may be the most effective way to colonize the bladder with beneficial microbes and reduce the colonization of uropathogens. Future researchers may choose to use this intervention in both neurogenic and non-neurogenic populations. Probiotic and cranberry supplementation for preventing recurrent uncomplicated urinary tract infections in premenopausal women: a controlled pilot study​”Cranberry (Vaccinium macrocarpon) is an evergreen shrub that grows in bogs in North America. It produces dark red fruits that contain salicylic acid. McMurdo, M. E., Bissett, L. Y., Price, R. J., Phillips, G., and Crombie, I. K. Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in hospital? A double-blind, placebo-controlled trial. Age Ageing 2005;34(3):256-261. View abstract. Tsukada, K., Tokunaga, K., Iwama, T., Mishima, Y., Tazawa, K., and Fujimaki, M. Cranberry juice and its impact on peri-stomal skin conditions for urostomy patients. Ostomy.Wound.Manage. 1994;40(9):60-68. View abstract. Yamanaka, A., Kimizuka, R., Kato, T., and Okuda, K. Inhibitory effects of cranberry juice on attachment of oral streptococci and biofilm formation. Oral Microbiol.Immunol. 2004;19(3):150-154. View abstract. Niklasson, A. and Andren, L. [Interaction between Waran and cranberry juice]. Lakartidningen 3-15-2006;103(11):853-854. View abstract.