Efficacy of D-mannose as prophylaxis of recurrent urinary tract infection: a systematic review and meta-analysis of randomized controlled trials.

Recurrent urinary tract infections (UTIs) significantly impact the quality of life due to symptoms, effects on sexual activity, persistent pain, and recurrent antibiotic use. This systematic review and meta-analysis aimed to evaluate the efficacy of D-mannose in preventing recurrent UTIs. In May 2024, we systematically searched PubMed, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) comparing D-mannose treatment with no intervention or standard antibiotic therapy in patients at high risk for recurrent UTI. We applied a random-effects model to pool relative risks (RR) and 95% confidence intervals (CI). We included 6 RCTs comprising 1,167 participants, of whom 534 received D-mannose and 521 (97.6%) were women. D-mannose was not associated with a reduction in recurrent UTI compared with control (RR: 0.57, 95% CI 0.29 - 1.15; p < 0.01) or antibiotics (RR: 0.39, 95% CI 0.12 - 1.25; p < 0.01). Further analyses showed that D-mannose did not improve outcomes in a subgroup of postmenopausal women. In this meta-analysis of RCTs, D-mannose did not reduce the incidence of recurrent UTIs compared with control or antibiotics in high-risk patients.