Role of D-mannose in urinary tract infections - a narrative review

Abstract

Urinary tract infections (UTIs) are one of the most prevalent bacterial diseases worldwide. Despite the efficacy of antibiotics targeted against UTI, the recurrence rates remain significant among the patients. Furthermore, the development of antibiotic resistance is a major concern and creates a demand for alternative treatment options. D-mannose, a monosaccharide naturally found in fruits, is commonly marketed as a dietary supplement for reducing the risk for UTIs. Research suggests that supplemented D-mannose could be a promising alternative or complementary remedy especially as a prophylaxis for recurrent UTIs. When excreted in urine, D-mannose potentially inhibits Escherichia coli, the main causative organism of UTIs, from attaching to urothelium and causing infection. In this review, we provide an overview of UTIs, E. coli pathogenesis and D-mannose and outline the existing clinical evidence of D-mannose in reducing the risk of UTI and its recurrence. Furthermore, we discuss the potential effect mechanisms of D-mannose against uropathogenic E.coli.

Keywords: D-mannose; UTI; Urinary tract infection, Escherichia coli.

Fig. 1

Schematic representation of E. coli attachment by FimH tips of the type 1 pili adhesins to mannosylated uroplakins on the surface of uroepithelium

Fig. 2

D-mannose, from supplementation to urine. Roughly one third of supplemented D-mannose ends up into urine where it has the potential to block pathogenic Escherichia coli from adhering to uroepithelial cells. Some of the D-mannose can be detected in the feces and some is utilized within the target tissues