Re: Article on UTI and Cranberry Products

July 23, 2012

Hmmm.

Mom loved cranberry juice and it was one of those drinks we could keep in

her room at the SNF without refrigeration. And though she did have a

couple of UTIs, I don't think there were more than 3 in the last 10 years

of her life.

Toward the end, though, cranberry juice was too thin for her to drink

successfully. At that point, she craved grape juice.

Kate

On Mon, Jul 23, 2012 at 2:47 PM, Mayhew wrote:

> **

>

> From Medscape Education Clinical

> Briefs<http://www.medscape.org/index/list_968_0>Protection

> Against Urinary Tract Infections Seen With Cranberry Products CME/CE

>

> News Author: Troy Brown

> CME Author: Désirée Lie, MD, MSEd

>

> Faculty and Disclosures<

> http://www.medscape.org/viewarticle/767190?src=cmemp>

>

> CME/CE Released: 07/11/2012; Valid for credit through 07/11/2013

> CME/CE Information <http://www.medscape.org/viewarticle/767190?src=cmemp>

> Earn

> CME/CE Credit »<

> http://www.medscape.org/qna/processor/25609?showStandAlone=true>

> CLINICAL CONTEXT

>

> According to the current study by Wang and colleagues, urinary tract

> infection (UTI) is one of the most commonly acquired bacterial infections,

> and cranberry-containing products have long been used as a folk remedy to

> prevent UTIs. Up to 40% to 50% of women will experience at least 1 episode

> of UTI during their lifetimes. Approximately 20% to 30% of women who have

> had an infection will experience a recurrence. Other groups with an

> increased risk for UTI include pregnant women, elderly patients, and

> patients with neuropathic bladder.

>

> This systematic review and meta-analysis of randomized controlled trials

> determines the efficacy of cranberry products in the prevention of UTIs.

> STUDY SYNOPSIS AND PERSPECTIVE

>

> Cranberry-containing products may protect against UTIs, according to a

> recent

> meta-analysis<

> http://archinte.jamanetwork.com/article.aspx?articleid=1213845>.

> However, because there was substantial heterogeneity among the studies, the

> results of the analysis should be viewed with caution, the researchers say.

>

> Chih-Hung Wang, MD, from the Department of Emergency Medicine at National

> Taiwan University Hospital and National Taiwan University College of

> Medicine in Taipei and colleagues report their findings in the July 9 issue

> of the*Archives of Internal Medicine*.

>

> One of the most common bacterial infections, UTIs affect up to 40% to 50%

> of women at least once in their lifetimes, the authors report. Pregnant

> women, the elderly, and patients with neuropathic bladder are also at

> increased risk for developing UTIs.

>

> Cranberry (genus *Vaccinium*, including the species *V oxycoccus, V

> macrocarpon, V microcarpum*, and *V erythrocarpum*) is a folk remedy that

> has been used for years to relieve UTI symptoms. Cranberry was originally

> thought to work by acidifying the urine, but its effects are now known to

> be due to its interference with the attachment of bacteria to uroepithelial

> cells. In fact, A-type proanthocyanidins were identified in cranberry in

> 1989 as compounds with the potential to inhibit the adherence of

> P-fimbriated *Escherichia coli* to the urogenital mucosa.

>

> Several new studies have been published since the last meta-analysis on

> this issue. Therefore, Dr. Wang and his team wanted to reevaluate the

> effectiveness of cranberry products for preventing UTIs and to study

> factors that influence their effectiveness.

>

> Dr. Wang and colleagues analyzed 10 trials with a total of 1494

> participants (794 in the cranberry groups and 700 in the control groups) in

> the meta-analysis. Significant heterogeneity was found among trials

> (relative risk [RR], 0.68; 95% confidence interval [CI], 0.47 - 1.00; *I*

> *2

> * = 59%). One trial was excluded from the main analysis because it had the

> most significant effect on the pooled summary estimate.

>

> *Cranberry Products Appear Effective*

>

> Heterogeneity decreased after exclusion of this trial, and

> cranberry-containing products appeared to effectively prevent UTIs (RR,

> 0.62; 95% CI, 0.49 - 0.80; *I* *2* = 43%).

>

> According to sensitivity analysis, the pooled summary estimate was stable

> to risks of bias in random sequence generation, study characteristics, and

> definitions of UTI, but the protective effect was much stronger in 2

> studies that did not use placebo in the control group (pooled RR, 0.36; 95%

> CI, 0.21 - 0.62).

>

> *Certain Populations Seem to Benefit More*

>

> Subgroup analysis found that some populations seemed to experience higher

> protective effects, including women with recurrent UTIs (RR, 0.53; 95% CI,

> 0.33 - 0.83; *I* *2* = 0%), female populations (RR, 0.49; 95% CI, 0.34 -

> 0.73; *I* *2* = 34%), children (RR, 0.33; 95% CI, 0.16 - 0.69; *I* *2* =

> 0%), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72; *I* *2* = 2%),

> and people using cranberry-containing products more than twice daily (RR,

> 0.58; 95% CI, 0.40 - 0.84; *I* *2* = 18%). The findings, though, were not

> statistically significant in meta-regression.

>

> Cranberry juice was more effective than cranberry capsules. The authors

> write that this could be due to increased hydration from drinking the juice

> or the effects of unknown substances in the juice. The authors acknowledge

> that drinking large quantities of juice could be problematic for some

> individuals, including patients with diabetes and those with

> gastrointestinal issues.

>

> A dosing frequency of more than twice daily was more effective. " Because in

> vitro data have suggested that the antiadhesion activity of cranberry juice

> on fimbriated *E coli* lasts for approximately 8 hours after ingestion,

> dosing more frequently than twice daily may be a reasonable choice, " write

> the authors.

>

> *Caution Needed*

>

> " [T]he results of the present meta-analysis support that consumption of

> cranberry-containing products may protect against UTIs in certain

> populations. However, because of the substantial heterogeneity across

> trials, this conclusion should be interpreted with great caution, " the

> authors conclude.

>

> *The authors have disclosed no relevant financial relationships.*

>

> *Arch Intern Med*.

> 2012;172:988-996<

> http://archinte.jamanetwork.com/article.aspx?articleid=1213845>

> .

> STUDY HIGHLIGHTS

>

> - The investigators systematically searched MEDLINE, EMBASE, and the

> Cochrane Central Register of Controlled Trials from inception to November

> 2011 for randomized controlled trials that compared prevention of UTIs in

> users of cranberry-containing products vs placebo or nonplacebo controls.

> - There were no restrictions for language, population, or publication

> year.

> - 2 authors independently scanned the titles and abstracts of all

> retrieved manuscripts to identify those pertinent to the review.

> - Excluded were abstracts from conferences, proceedings, or clinical

> trial registries.

> - The investigators also manually searched bibliographies of relevant

> studies, reviews, and meta-analyses to identify references that may have

> been missed in the primary search.

> - Prespecified inclusion criteria were randomized controlled trials,

> comparison of cranberry-containing products vs placebo or nonplacebo

> control for prevention of UTI, and outcomes reported as incidence of UTIs.

> - The primary outcome was prespecified as the incidence of UTI, which

> was expressed as either incidence or cumulative incidence rate, depending

> on the original data.

> - The Cochrane risk for bias tool was adopted to assess the risk for

> bias for each trial, which was scored as " high risk, " " low risk, " or

> " unclear. "

> - 13 studies were identified as eligible for qualitative analysis, and

> there were 9 parallel-group and 4 crossover trials.

> - Of the 13 trials, 10 were performed in North America and 3 in Europe.

> - All but 1 of the trials observed participants living in the community.

> - Women with recurrent UTIs, elderly patients, patients with neuropathic

> bladder, pregnant women, and children underwent further subgroup analysis.

> - Administration of cranberry-containing products differed significantly

> in form, daily dosage, A-type proanthocyanidin content, and dosing

> frequency.

> - 9 trials used cranberry juice, and 4 used cranberry capsules or

> tablets.

> - 6 trials used cranberry-containing products provided by a specific

> manufacturer.

> - Daily cranberry dose ranged from 0.4 to 194.4 g.

> - In trials using daily cranberry amounts greater than 10 g, a huge

> range of A-type proanthocyanidins, from 0.838 mg to 224 mg per day, was

> reported.

> - In contrast, those using daily cranberry amounts of less than 10 g did

> not include information about A-type proanthocyanidin content.

> - Cranberry-containing products were administered for 6 months in most

> trials.

> - 10 trials used a formulated placebo, 2 trials did not use a placebo,

> and 1 trial used water as the placebo.

> - 1494 participants across the 10 trials included in the quantitative

> data synthesis, with 794 in the cranberry group and 700 in the control

> group.

> - There was significant heterogeneity among trials.

> - The random-effects pooled RR for cranberry users vs nonusers was 0.62

> (95% CI, 0.49 - 0.80), with a moderate degree of heterogeneity (*I* 2 =

> 43%) after the exclusion of 1 outlier study.

> - A better preventive effect from cranberry-containing products was

> noted with dosing frequency more than twice daily.

> - Subgroup analysis showed that cranberry products seemed to be more

> effective in women with recurrent UTIs (RR, 0.53; 95% CI, 0.33 - 0.83),

> female populations (RR, 0.49; 95% CI, 0.34 - 0.73), children (RR, 0.33; 95%

> CI, 0.16 - 0.69), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72),

> and people using cranberry-containing products more than twice daily (RR,

> 0.58; 95% CI, 0.40 - 0.84).

> - The authors concluded that cranberry-containing products were

> associated with a protective effect against UTIs but that the result should

> be interpreted in the context of substantial heterogeneity across trials.

>

> CLINICAL IMPLICATIONS

>

> - Use of cranberry products is associated with a reduction in the risk

> for recurrent UTIs.

> - The benefits of cranberry products for UTI prevention are greater in

> women with recurrent UTI, female populations, children, those who drink

> cranberry juice, and those who use the products more than twice daily.

>

July 23, 2012

And let us not forget " Cosmopolitans.....great for relieving care givers.

Marilynn

To: LBD_caringspouses ; LBDcaregivers

Sent: Monday, July 23, 2012 3:47 PM

Subject: Article on UTI and Cranberry Products

Â

From Medscape Education Clinical

Briefs<http://www.medscape.org/index/list_968_0>Protection

Against Urinary Tract Infections Seen With Cranberry Products CME/CE

News Author: Troy Brown

CME Author: DÃ©sirÃ©e Lie, MD, MSEd

Faculty and Disclosures<http://www.medscape.org/viewarticle/767190?src=cmemp>

CME/CE Released: 07/11/2012; Valid for credit through 07/11/2013

CME/CE Information <http://www.medscape.org/viewarticle/767190?src=cmemp> Earn

CME/CE Credit

Â»<http://www.medscape.org/qna/processor/25609?showStandAlone=true>

CLINICAL CONTEXT

According to the current study by Wang and colleagues, urinary tract

infection (UTI) is one of the most commonly acquired bacterial infections,

and cranberry-containing products have long been used as a folk remedy to

prevent UTIs. Up to 40% to 50% of women will experience at least 1 episode

of UTI during their lifetimes. Approximately 20% to 30% of women who have

had an infection will experience a recurrence. Other groups with an

increased risk for UTI include pregnant women, elderly patients, and

patients with neuropathic bladder.

This systematic review and meta-analysis of randomized controlled trials

determines the efficacy of cranberry products in the prevention of UTIs.

STUDY SYNOPSIS AND PERSPECTIVE

Cranberry-containing products may protect against UTIs, according to a recent

meta-analysis<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>.

However, because there was substantial heterogeneity among the studies, the

results of the analysis should be viewed with caution, the researchers say.

Chih-Hung Wang, MD, from the Department of Emergency Medicine at National

Taiwan University Hospital and National Taiwan University College of

Medicine in Taipei and colleagues report their findings in the July 9 issue

of the*Archives of Internal Medicine*.

One of the most common bacterial infections, UTIs affect up to 40% to 50%

of women at least once in their lifetimes, the authors report. Pregnant

women, the elderly, and patients with neuropathic bladder are also at

increased risk for developing UTIs.

Cranberry (genus *Vaccinium*, including the species *V oxycoccus, V

macrocarpon, V microcarpum*, and *V erythrocarpum*) is a folk remedy that

has been used for years to relieve UTI symptoms. Cranberry was originally

thought to work by acidifying the urine, but its effects are now known to

be due to its interference with the attachment of bacteria to uroepithelial

cells. In fact, A-type proanthocyanidins were identified in cranberry in

1989 as compounds with the potential to inhibit the adherence of

P-fimbriated *Escherichia coli* to the urogenital mucosa.

Several new studies have been published since the last meta-analysis on

this issue. Therefore, Dr. Wang and his team wanted to reevaluate the

effectiveness of cranberry products for preventing UTIs and to study

factors that influence their effectiveness.

Dr. Wang and colleagues analyzed 10 trials with a total of 1494

participants (794 in the cranberry groups and 700 in the control groups) in

the meta-analysis. Significant heterogeneity was found among trials

(relative risk [RR], 0.68; 95% confidence interval [CI], 0.47 - 1.00; *I* *2

* = 59%). One trial was excluded from the main analysis because it had the

most significant effect on the pooled summary estimate.

*Cranberry Products Appear Effective*

Heterogeneity decreased after exclusion of this trial, and

cranberry-containing products appeared to effectively prevent UTIs (RR,

0.62; 95% CI, 0.49 - 0.80; *I* *2* = 43%).

According to sensitivity analysis, the pooled summary estimate was stable

to risks of bias in random sequence generation, study characteristics, and

definitions of UTI, but the protective effect was much stronger in 2

studies that did not use placebo in the control group (pooled RR, 0.36; 95%

CI, 0.21 - 0.62).

*Certain Populations Seem to Benefit More*

Subgroup analysis found that some populations seemed to experience higher

protective effects, including women with recurrent UTIs (RR, 0.53; 95% CI,

0.33 - 0.83; *I* *2* = 0%), female populations (RR, 0.49; 95% CI, 0.34 -

0.73; *I* *2* = 34%), children (RR, 0.33; 95% CI, 0.16 - 0.69; *I* *2* =

0%), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72; *I* *2* = 2%),

and people using cranberry-containing products more than twice daily (RR,

0.58; 95% CI, 0.40 - 0.84; *I* *2* = 18%). The findings, though, were not

statistically significant in meta-regression.

Cranberry juice was more effective than cranberry capsules. The authors

write that this could be due to increased hydration from drinking the juice

or the effects of unknown substances in the juice. The authors acknowledge

that drinking large quantities of juice could be problematic for some

individuals, including patients with diabetes and those with

gastrointestinal issues.

A dosing frequency of more than twice daily was more effective. " Because in

vitro data have suggested that the antiadhesion activity of cranberry juice

on fimbriated *E coli* lasts for approximately 8 hours after ingestion,

dosing more frequently than twice daily may be a reasonable choice, " write

the authors.

*Caution Needed*

" [T]he results of the present meta-analysis support that consumption of

cranberry-containing products may protect against UTIs in certain

populations. However, because of the substantial heterogeneity across

trials, this conclusion should be interpreted with great caution, " the

authors conclude.

*The authors have disclosed no relevant financial relationships.*

*Arch Intern Med*.

2012;172:988-996<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>

..

STUDY HIGHLIGHTS

- The investigators systematically searched MEDLINE, EMBASE, and the

Cochrane Central Register of Controlled Trials from inception to November

2011 for randomized controlled trials that compared prevention of UTIs in

users of cranberry-containing products vs placebo or nonplacebo controls.

- There were no restrictions for language, population, or publication

year.

- 2 authors independently scanned the titles and abstracts of all

retrieved manuscripts to identify those pertinent to the review.

- Excluded were abstracts from conferences, proceedings, or clinical

trial registries.

- The investigators also manually searched bibliographies of relevant

studies, reviews, and meta-analyses to identify references that may have

been missed in the primary search.

- Prespecified inclusion criteria were randomized controlled trials,

comparison of cranberry-containing products vs placebo or nonplacebo

control for prevention of UTI, and outcomes reported as incidence of UTIs.

- The primary outcome was prespecified as the incidence of UTI, which

was expressed as either incidence or cumulative incidence rate, depending

on the original data.

- The Cochrane risk for bias tool was adopted to assess the risk for

bias for each trial, which was scored as " high risk, " " low risk, " or

" unclear. "

- 13 studies were identified as eligible for qualitative analysis, and

there were 9 parallel-group and 4 crossover trials.

- Of the 13 trials, 10 were performed in North America and 3 in Europe.

- All but 1 of the trials observed participants living in the community.

- Women with recurrent UTIs, elderly patients, patients with neuropathic

bladder, pregnant women, and children underwent further subgroup analysis.

- Administration of cranberry-containing products differed significantly

in form, daily dosage, A-type proanthocyanidin content, and dosing

frequency.

- 9 trials used cranberry juice, and 4 used cranberry capsules or

tablets.

- 6 trials used cranberry-containing products provided by a specific

manufacturer.

- Daily cranberry dose ranged from 0.4 to 194.4 g.

- In trials using daily cranberry amounts greater than 10 g, a huge

range of A-type proanthocyanidins, from 0.838 mg to 224 mg per day, was

reported.

- In contrast, those using daily cranberry amounts of less than 10 g did

not include information about A-type proanthocyanidin content.

- Cranberry-containing products were administered for 6 months in most

trials.

- 10 trials used a formulated placebo, 2 trials did not use a placebo,

and 1 trial used water as the placebo.

- 1494 participants across the 10 trials included in the quantitative

data synthesis, with 794 in the cranberry group and 700 in the control

group.

- There was significant heterogeneity among trials.

- The random-effects pooled RR for cranberry users vs nonusers was 0.62

(95% CI, 0.49 - 0.80), with a moderate degree of heterogeneity (*I* 2 =

43%) after the exclusion of 1 outlier study.

- A better preventive effect from cranberry-containing products was

noted with dosing frequency more than twice daily.

- Subgroup analysis showed that cranberry products seemed to be more

effective in women with recurrent UTIs (RR, 0.53; 95% CI, 0.33 - 0.83),

female populations (RR, 0.49; 95% CI, 0.34 - 0.73), children (RR, 0.33; 95%

CI, 0.16 - 0.69), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72),

and people using cranberry-containing products more than twice daily (RR,

0.58; 95% CI, 0.40 - 0.84).

- The authors concluded that cranberry-containing products were

associated with a protective effect against UTIs but that the result should

be interpreted in the context of substantial heterogeneity across trials.

CLINICAL IMPLICATIONS

- Use of cranberry products is associated with a reduction in the risk

for recurrent UTIs.

- The benefits of cranberry products for UTI prevention are greater in

women with recurrent UTI, female populations, children, those who drink

cranberry juice, and those who use the products more than twice daily.

July 23, 2012

And let us not forget " Cosmopolitans.....great for relieving care givers.

Marilynn

To: LBD_caringspouses ; LBDcaregivers

Sent: Monday, July 23, 2012 3:47 PM

Subject: Article on UTI and Cranberry Products

Â

From Medscape Education Clinical

Briefs<http://www.medscape.org/index/list_968_0>Protection

Against Urinary Tract Infections Seen With Cranberry Products CME/CE

News Author: Troy Brown

CME Author: DÃ©sirÃ©e Lie, MD, MSEd

Faculty and Disclosures<http://www.medscape.org/viewarticle/767190?src=cmemp>

CME/CE Released: 07/11/2012; Valid for credit through 07/11/2013

CME/CE Information <http://www.medscape.org/viewarticle/767190?src=cmemp> Earn

CME/CE Credit

Â»<http://www.medscape.org/qna/processor/25609?showStandAlone=true>

CLINICAL CONTEXT

According to the current study by Wang and colleagues, urinary tract

infection (UTI) is one of the most commonly acquired bacterial infections,

and cranberry-containing products have long been used as a folk remedy to

prevent UTIs. Up to 40% to 50% of women will experience at least 1 episode

of UTI during their lifetimes. Approximately 20% to 30% of women who have

had an infection will experience a recurrence. Other groups with an

increased risk for UTI include pregnant women, elderly patients, and

patients with neuropathic bladder.

This systematic review and meta-analysis of randomized controlled trials

determines the efficacy of cranberry products in the prevention of UTIs.

STUDY SYNOPSIS AND PERSPECTIVE

Cranberry-containing products may protect against UTIs, according to a recent

meta-analysis<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>.

However, because there was substantial heterogeneity among the studies, the

results of the analysis should be viewed with caution, the researchers say.

Chih-Hung Wang, MD, from the Department of Emergency Medicine at National

Taiwan University Hospital and National Taiwan University College of

Medicine in Taipei and colleagues report their findings in the July 9 issue

of the*Archives of Internal Medicine*.

One of the most common bacterial infections, UTIs affect up to 40% to 50%

of women at least once in their lifetimes, the authors report. Pregnant

women, the elderly, and patients with neuropathic bladder are also at

increased risk for developing UTIs.

Cranberry (genus *Vaccinium*, including the species *V oxycoccus, V

macrocarpon, V microcarpum*, and *V erythrocarpum*) is a folk remedy that

has been used for years to relieve UTI symptoms. Cranberry was originally

thought to work by acidifying the urine, but its effects are now known to

be due to its interference with the attachment of bacteria to uroepithelial

cells. In fact, A-type proanthocyanidins were identified in cranberry in

1989 as compounds with the potential to inhibit the adherence of

P-fimbriated *Escherichia coli* to the urogenital mucosa.

Several new studies have been published since the last meta-analysis on

this issue. Therefore, Dr. Wang and his team wanted to reevaluate the

effectiveness of cranberry products for preventing UTIs and to study

factors that influence their effectiveness.

Dr. Wang and colleagues analyzed 10 trials with a total of 1494

participants (794 in the cranberry groups and 700 in the control groups) in

the meta-analysis. Significant heterogeneity was found among trials

(relative risk [RR], 0.68; 95% confidence interval [CI], 0.47 - 1.00; *I* *2

* = 59%). One trial was excluded from the main analysis because it had the

most significant effect on the pooled summary estimate.

*Cranberry Products Appear Effective*

Heterogeneity decreased after exclusion of this trial, and

cranberry-containing products appeared to effectively prevent UTIs (RR,

0.62; 95% CI, 0.49 - 0.80; *I* *2* = 43%).

According to sensitivity analysis, the pooled summary estimate was stable

to risks of bias in random sequence generation, study characteristics, and

definitions of UTI, but the protective effect was much stronger in 2

studies that did not use placebo in the control group (pooled RR, 0.36; 95%

CI, 0.21 - 0.62).

*Certain Populations Seem to Benefit More*

Subgroup analysis found that some populations seemed to experience higher

protective effects, including women with recurrent UTIs (RR, 0.53; 95% CI,

0.33 - 0.83; *I* *2* = 0%), female populations (RR, 0.49; 95% CI, 0.34 -

0.73; *I* *2* = 34%), children (RR, 0.33; 95% CI, 0.16 - 0.69; *I* *2* =

0%), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72; *I* *2* = 2%),

and people using cranberry-containing products more than twice daily (RR,

0.58; 95% CI, 0.40 - 0.84; *I* *2* = 18%). The findings, though, were not

statistically significant in meta-regression.

Cranberry juice was more effective than cranberry capsules. The authors

write that this could be due to increased hydration from drinking the juice

or the effects of unknown substances in the juice. The authors acknowledge

that drinking large quantities of juice could be problematic for some

individuals, including patients with diabetes and those with

gastrointestinal issues.

A dosing frequency of more than twice daily was more effective. " Because in

vitro data have suggested that the antiadhesion activity of cranberry juice

on fimbriated *E coli* lasts for approximately 8 hours after ingestion,

dosing more frequently than twice daily may be a reasonable choice, " write

the authors.

*Caution Needed*

" [T]he results of the present meta-analysis support that consumption of

cranberry-containing products may protect against UTIs in certain

populations. However, because of the substantial heterogeneity across

trials, this conclusion should be interpreted with great caution, " the

authors conclude.

*The authors have disclosed no relevant financial relationships.*

*Arch Intern Med*.

2012;172:988-996<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>

..

STUDY HIGHLIGHTS

- The investigators systematically searched MEDLINE, EMBASE, and the

Cochrane Central Register of Controlled Trials from inception to November

2011 for randomized controlled trials that compared prevention of UTIs in

users of cranberry-containing products vs placebo or nonplacebo controls.

- There were no restrictions for language, population, or publication

year.

- 2 authors independently scanned the titles and abstracts of all

retrieved manuscripts to identify those pertinent to the review.

- Excluded were abstracts from conferences, proceedings, or clinical

trial registries.

- The investigators also manually searched bibliographies of relevant

studies, reviews, and meta-analyses to identify references that may have

been missed in the primary search.

- Prespecified inclusion criteria were randomized controlled trials,

comparison of cranberry-containing products vs placebo or nonplacebo

control for prevention of UTI, and outcomes reported as incidence of UTIs.

- The primary outcome was prespecified as the incidence of UTI, which

was expressed as either incidence or cumulative incidence rate, depending

on the original data.

- The Cochrane risk for bias tool was adopted to assess the risk for

bias for each trial, which was scored as " high risk, " " low risk, " or

" unclear. "

- 13 studies were identified as eligible for qualitative analysis, and

there were 9 parallel-group and 4 crossover trials.

- Of the 13 trials, 10 were performed in North America and 3 in Europe.

- All but 1 of the trials observed participants living in the community.

- Women with recurrent UTIs, elderly patients, patients with neuropathic

bladder, pregnant women, and children underwent further subgroup analysis.

- Administration of cranberry-containing products differed significantly

in form, daily dosage, A-type proanthocyanidin content, and dosing

frequency.

- 9 trials used cranberry juice, and 4 used cranberry capsules or

tablets.

- 6 trials used cranberry-containing products provided by a specific

manufacturer.

- Daily cranberry dose ranged from 0.4 to 194.4 g.

- In trials using daily cranberry amounts greater than 10 g, a huge

range of A-type proanthocyanidins, from 0.838 mg to 224 mg per day, was

reported.

- In contrast, those using daily cranberry amounts of less than 10 g did

not include information about A-type proanthocyanidin content.

- Cranberry-containing products were administered for 6 months in most

trials.

- 10 trials used a formulated placebo, 2 trials did not use a placebo,

and 1 trial used water as the placebo.

- 1494 participants across the 10 trials included in the quantitative

data synthesis, with 794 in the cranberry group and 700 in the control

group.

- There was significant heterogeneity among trials.

- The random-effects pooled RR for cranberry users vs nonusers was 0.62

(95% CI, 0.49 - 0.80), with a moderate degree of heterogeneity (*I* 2 =

43%) after the exclusion of 1 outlier study.

- A better preventive effect from cranberry-containing products was

noted with dosing frequency more than twice daily.

- Subgroup analysis showed that cranberry products seemed to be more

effective in women with recurrent UTIs (RR, 0.53; 95% CI, 0.33 - 0.83),

female populations (RR, 0.49; 95% CI, 0.34 - 0.73), children (RR, 0.33; 95%

CI, 0.16 - 0.69), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72),

and people using cranberry-containing products more than twice daily (RR,

0.58; 95% CI, 0.40 - 0.84).

- The authors concluded that cranberry-containing products were

associated with a protective effect against UTIs but that the result should

be interpreted in the context of substantial heterogeneity across trials.

CLINICAL IMPLICATIONS

- Use of cranberry products is associated with a reduction in the risk

for recurrent UTIs.

- The benefits of cranberry products for UTI prevention are greater in

women with recurrent UTI, female populations, children, those who drink

cranberry juice, and those who use the products more than twice daily.

July 23, 2012

And let us not forget " Cosmopolitans.....great for relieving care givers.

Marilynn

To: LBD_caringspouses ; LBDcaregivers

Sent: Monday, July 23, 2012 3:47 PM

Subject: Article on UTI and Cranberry Products

Â

From Medscape Education Clinical

Briefs<http://www.medscape.org/index/list_968_0>Protection

Against Urinary Tract Infections Seen With Cranberry Products CME/CE

News Author: Troy Brown

CME Author: DÃ©sirÃ©e Lie, MD, MSEd

Faculty and Disclosures<http://www.medscape.org/viewarticle/767190?src=cmemp>

CME/CE Released: 07/11/2012; Valid for credit through 07/11/2013

CME/CE Information <http://www.medscape.org/viewarticle/767190?src=cmemp> Earn

CME/CE Credit

Â»<http://www.medscape.org/qna/processor/25609?showStandAlone=true>

CLINICAL CONTEXT

According to the current study by Wang and colleagues, urinary tract

infection (UTI) is one of the most commonly acquired bacterial infections,

and cranberry-containing products have long been used as a folk remedy to

prevent UTIs. Up to 40% to 50% of women will experience at least 1 episode

of UTI during their lifetimes. Approximately 20% to 30% of women who have

had an infection will experience a recurrence. Other groups with an

increased risk for UTI include pregnant women, elderly patients, and

patients with neuropathic bladder.

This systematic review and meta-analysis of randomized controlled trials

determines the efficacy of cranberry products in the prevention of UTIs.

STUDY SYNOPSIS AND PERSPECTIVE

Cranberry-containing products may protect against UTIs, according to a recent

meta-analysis<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>.

However, because there was substantial heterogeneity among the studies, the

results of the analysis should be viewed with caution, the researchers say.

Chih-Hung Wang, MD, from the Department of Emergency Medicine at National

Taiwan University Hospital and National Taiwan University College of

Medicine in Taipei and colleagues report their findings in the July 9 issue

of the*Archives of Internal Medicine*.

One of the most common bacterial infections, UTIs affect up to 40% to 50%

of women at least once in their lifetimes, the authors report. Pregnant

women, the elderly, and patients with neuropathic bladder are also at

increased risk for developing UTIs.

Cranberry (genus *Vaccinium*, including the species *V oxycoccus, V

macrocarpon, V microcarpum*, and *V erythrocarpum*) is a folk remedy that

has been used for years to relieve UTI symptoms. Cranberry was originally

thought to work by acidifying the urine, but its effects are now known to

be due to its interference with the attachment of bacteria to uroepithelial

cells. In fact, A-type proanthocyanidins were identified in cranberry in

1989 as compounds with the potential to inhibit the adherence of

P-fimbriated *Escherichia coli* to the urogenital mucosa.

Several new studies have been published since the last meta-analysis on

this issue. Therefore, Dr. Wang and his team wanted to reevaluate the

effectiveness of cranberry products for preventing UTIs and to study

factors that influence their effectiveness.

Dr. Wang and colleagues analyzed 10 trials with a total of 1494

participants (794 in the cranberry groups and 700 in the control groups) in

the meta-analysis. Significant heterogeneity was found among trials

(relative risk [RR], 0.68; 95% confidence interval [CI], 0.47 - 1.00; *I* *2

* = 59%). One trial was excluded from the main analysis because it had the

most significant effect on the pooled summary estimate.

*Cranberry Products Appear Effective*

Heterogeneity decreased after exclusion of this trial, and

cranberry-containing products appeared to effectively prevent UTIs (RR,

0.62; 95% CI, 0.49 - 0.80; *I* *2* = 43%).

According to sensitivity analysis, the pooled summary estimate was stable

to risks of bias in random sequence generation, study characteristics, and

definitions of UTI, but the protective effect was much stronger in 2

studies that did not use placebo in the control group (pooled RR, 0.36; 95%

CI, 0.21 - 0.62).

*Certain Populations Seem to Benefit More*

Subgroup analysis found that some populations seemed to experience higher

protective effects, including women with recurrent UTIs (RR, 0.53; 95% CI,

0.33 - 0.83; *I* *2* = 0%), female populations (RR, 0.49; 95% CI, 0.34 -

0.73; *I* *2* = 34%), children (RR, 0.33; 95% CI, 0.16 - 0.69; *I* *2* =

0%), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72; *I* *2* = 2%),

and people using cranberry-containing products more than twice daily (RR,

0.58; 95% CI, 0.40 - 0.84; *I* *2* = 18%). The findings, though, were not

statistically significant in meta-regression.

Cranberry juice was more effective than cranberry capsules. The authors

write that this could be due to increased hydration from drinking the juice

or the effects of unknown substances in the juice. The authors acknowledge

that drinking large quantities of juice could be problematic for some

individuals, including patients with diabetes and those with

gastrointestinal issues.

A dosing frequency of more than twice daily was more effective. " Because in

vitro data have suggested that the antiadhesion activity of cranberry juice

on fimbriated *E coli* lasts for approximately 8 hours after ingestion,

dosing more frequently than twice daily may be a reasonable choice, " write

the authors.

*Caution Needed*

" [T]he results of the present meta-analysis support that consumption of

cranberry-containing products may protect against UTIs in certain

populations. However, because of the substantial heterogeneity across

trials, this conclusion should be interpreted with great caution, " the

authors conclude.

*The authors have disclosed no relevant financial relationships.*

*Arch Intern Med*.

2012;172:988-996<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>

..

STUDY HIGHLIGHTS

- The investigators systematically searched MEDLINE, EMBASE, and the

Cochrane Central Register of Controlled Trials from inception to November

2011 for randomized controlled trials that compared prevention of UTIs in

users of cranberry-containing products vs placebo or nonplacebo controls.

- There were no restrictions for language, population, or publication

year.

- 2 authors independently scanned the titles and abstracts of all

retrieved manuscripts to identify those pertinent to the review.

- Excluded were abstracts from conferences, proceedings, or clinical

trial registries.

- The investigators also manually searched bibliographies of relevant

studies, reviews, and meta-analyses to identify references that may have

been missed in the primary search.

- Prespecified inclusion criteria were randomized controlled trials,

comparison of cranberry-containing products vs placebo or nonplacebo

control for prevention of UTI, and outcomes reported as incidence of UTIs.

- The primary outcome was prespecified as the incidence of UTI, which

was expressed as either incidence or cumulative incidence rate, depending

on the original data.

- The Cochrane risk for bias tool was adopted to assess the risk for

bias for each trial, which was scored as " high risk, " " low risk, " or

" unclear. "

- 13 studies were identified as eligible for qualitative analysis, and

there were 9 parallel-group and 4 crossover trials.

- Of the 13 trials, 10 were performed in North America and 3 in Europe.

- All but 1 of the trials observed participants living in the community.

- Women with recurrent UTIs, elderly patients, patients with neuropathic

bladder, pregnant women, and children underwent further subgroup analysis.

- Administration of cranberry-containing products differed significantly

in form, daily dosage, A-type proanthocyanidin content, and dosing

frequency.

- 9 trials used cranberry juice, and 4 used cranberry capsules or

tablets.

- 6 trials used cranberry-containing products provided by a specific

manufacturer.

- Daily cranberry dose ranged from 0.4 to 194.4 g.

- In trials using daily cranberry amounts greater than 10 g, a huge

range of A-type proanthocyanidins, from 0.838 mg to 224 mg per day, was

reported.

- In contrast, those using daily cranberry amounts of less than 10 g did

not include information about A-type proanthocyanidin content.

- Cranberry-containing products were administered for 6 months in most

trials.

- 10 trials used a formulated placebo, 2 trials did not use a placebo,

and 1 trial used water as the placebo.

- 1494 participants across the 10 trials included in the quantitative

data synthesis, with 794 in the cranberry group and 700 in the control

group.

- There was significant heterogeneity among trials.

- The random-effects pooled RR for cranberry users vs nonusers was 0.62

(95% CI, 0.49 - 0.80), with a moderate degree of heterogeneity (*I* 2 =

43%) after the exclusion of 1 outlier study.

- A better preventive effect from cranberry-containing products was

noted with dosing frequency more than twice daily.

- Subgroup analysis showed that cranberry products seemed to be more

effective in women with recurrent UTIs (RR, 0.53; 95% CI, 0.33 - 0.83),

female populations (RR, 0.49; 95% CI, 0.34 - 0.73), children (RR, 0.33; 95%

CI, 0.16 - 0.69), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72),

and people using cranberry-containing products more than twice daily (RR,

0.58; 95% CI, 0.40 - 0.84).

- The authors concluded that cranberry-containing products were

associated with a protective effect against UTIs but that the result should

be interpreted in the context of substantial heterogeneity across trials.

CLINICAL IMPLICATIONS

- Use of cranberry products is associated with a reduction in the risk

for recurrent UTIs.

- The benefits of cranberry products for UTI prevention are greater in

women with recurrent UTI, female populations, children, those who drink

cranberry juice, and those who use the products more than twice daily.

July 23, 2012

Quoting Mayhew :

I've heard this = but my mom is allergic to cranberries - she gets an

itchy rash in a day

I've read about other stuff - Clear TRACT for one ... has anyone ever

tried any of these products

Mom (non-LBD) has a chronic UTI and is on continuous low dose

antibiotics - ever other day to keep it down

thanks

DonnaNJ

> From Medscape Education Clinical

> Briefs<http://www.medscape.org/index/list_968_0>Protection

> Against Urinary Tract Infections Seen With Cranberry Products CME/CE

>

> News Author: Troy Brown

> CME Author: Désirée Lie, MD, MSEd

>

> Faculty and Disclosures<http://www.medscape.org/viewarticle/767190?src=cmemp>

>

> CME/CE Released: 07/11/2012; Valid for credit through 07/11/2013

> CME/CE Information

> <http://www.medscape.org/viewarticle/767190?src=cmemp> Earn

> CME/CE Credit

> »<http://www.medscape.org/qna/processor/25609?showStandAlone=true>

> CLINICAL CONTEXT

>

> According to the current study by Wang and colleagues, urinary tract

> infection (UTI) is one of the most commonly acquired bacterial infections,

> and cranberry-containing products have long been used as a folk remedy to

> prevent UTIs. Up to 40% to 50% of women will experience at least 1 episode

> of UTI during their lifetimes. Approximately 20% to 30% of women who have

> had an infection will experience a recurrence. Other groups with an

> increased risk for UTI include pregnant women, elderly patients, and

> patients with neuropathic bladder.

>

> This systematic review and meta-analysis of randomized controlled trials

> determines the efficacy of cranberry products in the prevention of UTIs.

> STUDY SYNOPSIS AND PERSPECTIVE

>

> Cranberry-containing products may protect against UTIs, according to a recent

> meta-analysis<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>.

> However, because there was substantial heterogeneity among the studies, the

> results of the analysis should be viewed with caution, the researchers say.

>

> Chih-Hung Wang, MD, from the Department of Emergency Medicine at National

> Taiwan University Hospital and National Taiwan University College of

> Medicine in Taipei and colleagues report their findings in the July 9 issue

> of the*Archives of Internal Medicine*.

>

> One of the most common bacterial infections, UTIs affect up to 40% to 50%

> of women at least once in their lifetimes, the authors report. Pregnant

> women, the elderly, and patients with neuropathic bladder are also at

> increased risk for developing UTIs.

>

> Cranberry (genus *Vaccinium*, including the species *V oxycoccus, V

> macrocarpon, V microcarpum*, and *V erythrocarpum*) is a folk remedy that

> has been used for years to relieve UTI symptoms. Cranberry was originally

> thought to work by acidifying the urine, but its effects are now known to

> be due to its interference with the attachment of bacteria to uroepithelial

> cells. In fact, A-type proanthocyanidins were identified in cranberry in

> 1989 as compounds with the potential to inhibit the adherence of

> P-fimbriated *Escherichia coli* to the urogenital mucosa.

>

> Several new studies have been published since the last meta-analysis on

> this issue. Therefore, Dr. Wang and his team wanted to reevaluate the

> effectiveness of cranberry products for preventing UTIs and to study

> factors that influence their effectiveness.

>

> Dr. Wang and colleagues analyzed 10 trials with a total of 1494

> participants (794 in the cranberry groups and 700 in the control groups) in

> the meta-analysis. Significant heterogeneity was found among trials

> (relative risk [RR], 0.68; 95% confidence interval [CI], 0.47 - 1.00; *I* *2

> * = 59%). One trial was excluded from the main analysis because it had the

> most significant effect on the pooled summary estimate.

>

> *Cranberry Products Appear Effective*

>

> Heterogeneity decreased after exclusion of this trial, and

> cranberry-containing products appeared to effectively prevent UTIs (RR,

> 0.62; 95% CI, 0.49 - 0.80; *I* *2* = 43%).

>

> According to sensitivity analysis, the pooled summary estimate was stable

> to risks of bias in random sequence generation, study characteristics, and

> definitions of UTI, but the protective effect was much stronger in 2

> studies that did not use placebo in the control group (pooled RR, 0.36; 95%

> CI, 0.21 - 0.62).

>

> *Certain Populations Seem to Benefit More*

>

> Subgroup analysis found that some populations seemed to experience higher

> protective effects, including women with recurrent UTIs (RR, 0.53; 95% CI,

> 0.33 - 0.83; *I* *2* = 0%), female populations (RR, 0.49; 95% CI, 0.34 -

> 0.73; *I* *2* = 34%), children (RR, 0.33; 95% CI, 0.16 - 0.69; *I* *2* =

> 0%), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72; *I* *2* = 2%),

> and people using cranberry-containing products more than twice daily (RR,

> 0.58; 95% CI, 0.40 - 0.84; *I* *2* = 18%). The findings, though, were not

> statistically significant in meta-regression.

>

> Cranberry juice was more effective than cranberry capsules. The authors

> write that this could be due to increased hydration from drinking the juice

> or the effects of unknown substances in the juice. The authors acknowledge

> that drinking large quantities of juice could be problematic for some

> individuals, including patients with diabetes and those with

> gastrointestinal issues.

>

> A dosing frequency of more than twice daily was more effective. " Because in

> vitro data have suggested that the antiadhesion activity of cranberry juice

> on fimbriated *E coli* lasts for approximately 8 hours after ingestion,

> dosing more frequently than twice daily may be a reasonable choice, " write

> the authors.

>

> *Caution Needed*

>

> " [T]he results of the present meta-analysis support that consumption of

> cranberry-containing products may protect against UTIs in certain

> populations. However, because of the substantial heterogeneity across

> trials, this conclusion should be interpreted with great caution, " the

> authors conclude.

>

> *The authors have disclosed no relevant financial relationships.*

>

> *Arch Intern Med*.

>

2012;172:988-996<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>

> .

> STUDY HIGHLIGHTS

>

> - The investigators systematically searched MEDLINE, EMBASE, and the

> Cochrane Central Register of Controlled Trials from inception to November

> 2011 for randomized controlled trials that compared prevention of UTIs in

> users of cranberry-containing products vs placebo or nonplacebo controls.

> - There were no restrictions for language, population, or publication

> year.

> - 2 authors independently scanned the titles and abstracts of all

> retrieved manuscripts to identify those pertinent to the review.

> - Excluded were abstracts from conferences, proceedings, or clinical

> trial registries.

> - The investigators also manually searched bibliographies of relevant

> studies, reviews, and meta-analyses to identify references that may have

> been missed in the primary search.

> - Prespecified inclusion criteria were randomized controlled trials,

> comparison of cranberry-containing products vs placebo or nonplacebo

> control for prevention of UTI, and outcomes reported as incidence of UTIs.

> - The primary outcome was prespecified as the incidence of UTI, which

> was expressed as either incidence or cumulative incidence rate, depending

> on the original data.

> - The Cochrane risk for bias tool was adopted to assess the risk for

> bias for each trial, which was scored as " high risk, " " low risk, " or

> " unclear. "

> - 13 studies were identified as eligible for qualitative analysis, and

> there were 9 parallel-group and 4 crossover trials.

> - Of the 13 trials, 10 were performed in North America and 3 in Europe..

> - All but 1 of the trials observed participants living in the community.

> - Women with recurrent UTIs, elderly patients, patients with neuropathic

> bladder, pregnant women, and children underwent further subgroup analysis.

> - Administration of cranberry-containing products differed significantly

> in form, daily dosage, A-type proanthocyanidin content, and dosing

> frequency.

> - 9 trials used cranberry juice, and 4 used cranberry capsules or

> tablets.

> - 6 trials used cranberry-containing products provided by a specific

> manufacturer.

> - Daily cranberry dose ranged from 0.4 to 194.4 g.

> - In trials using daily cranberry amounts greater than 10 g, a huge

> range of A-type proanthocyanidins, from 0.838 mg to 224 mg per day, was

> reported.

> - In contrast, those using daily cranberry amounts of less than 10 g did

> not include information about A-type proanthocyanidin content.

> - Cranberry-containing products were administered for 6 months in most

> trials.

> - 10 trials used a formulated placebo, 2 trials did not use a placebo,

> and 1 trial used water as the placebo.

> - 1494 participants across the 10 trials included in the quantitative

> data synthesis, with 794 in the cranberry group and 700 in the control

> group.

> - There was significant heterogeneity among trials.

> - The random-effects pooled RR for cranberry users vs nonusers was 0.62

> (95% CI, 0.49 - 0.80), with a moderate degree of heterogeneity (*I* 2 =

> 43%) after the exclusion of 1 outlier study.

> - A better preventive effect from cranberry-containing products was

> noted with dosing frequency more than twice daily.

> - Subgroup analysis showed that cranberry products seemed to be more

> effective in women with recurrent UTIs (RR, 0.53; 95% CI, 0.33 - 0.83),

> female populations (RR, 0.49; 95% CI, 0.34 - 0.73), children (RR,

> 0.33; 95%

> CI, 0.16 - 0.69), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72),

> and people using cranberry-containing products more than twice daily (RR,

> 0.58; 95% CI, 0.40 - 0.84).

> - The authors concluded that cranberry-containing products were

> associated with a protective effect against UTIs but that the

> result should

> be interpreted in the context of substantial heterogeneity across trials.

>

> CLINICAL IMPLICATIONS

>

> - Use of cranberry products is associated with a reduction in the risk

> for recurrent UTIs.

> - The benefits of cranberry products for UTI prevention are greater in

> women with recurrent UTI, female populations, children, those who drink

> cranberry juice, and those who use the products more than twice daily.

>

July 23, 2012

Quoting Mayhew :

I've heard this = but my mom is allergic to cranberries - she gets an

itchy rash in a day

I've read about other stuff - Clear TRACT for one ... has anyone ever

tried any of these products

Mom (non-LBD) has a chronic UTI and is on continuous low dose

antibiotics - ever other day to keep it down

thanks

DonnaNJ

> From Medscape Education Clinical

> Briefs<http://www.medscape.org/index/list_968_0>Protection

> Against Urinary Tract Infections Seen With Cranberry Products CME/CE

>

> News Author: Troy Brown

> CME Author: Désirée Lie, MD, MSEd

>

> Faculty and Disclosures<http://www.medscape.org/viewarticle/767190?src=cmemp>

>

> CME/CE Released: 07/11/2012; Valid for credit through 07/11/2013

> CME/CE Information

> <http://www.medscape.org/viewarticle/767190?src=cmemp> Earn

> CME/CE Credit

> »<http://www.medscape.org/qna/processor/25609?showStandAlone=true>

> CLINICAL CONTEXT

>

> According to the current study by Wang and colleagues, urinary tract

> infection (UTI) is one of the most commonly acquired bacterial infections,

> and cranberry-containing products have long been used as a folk remedy to

> prevent UTIs. Up to 40% to 50% of women will experience at least 1 episode

> of UTI during their lifetimes. Approximately 20% to 30% of women who have

> had an infection will experience a recurrence. Other groups with an

> increased risk for UTI include pregnant women, elderly patients, and

> patients with neuropathic bladder.

>

> This systematic review and meta-analysis of randomized controlled trials

> determines the efficacy of cranberry products in the prevention of UTIs.

> STUDY SYNOPSIS AND PERSPECTIVE

>

> Cranberry-containing products may protect against UTIs, according to a recent

> meta-analysis<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>.

> However, because there was substantial heterogeneity among the studies, the

> results of the analysis should be viewed with caution, the researchers say.

>

> Chih-Hung Wang, MD, from the Department of Emergency Medicine at National

> Taiwan University Hospital and National Taiwan University College of

> Medicine in Taipei and colleagues report their findings in the July 9 issue

> of the*Archives of Internal Medicine*.

>

> One of the most common bacterial infections, UTIs affect up to 40% to 50%

> of women at least once in their lifetimes, the authors report. Pregnant

> women, the elderly, and patients with neuropathic bladder are also at

> increased risk for developing UTIs.

>

> Cranberry (genus *Vaccinium*, including the species *V oxycoccus, V

> macrocarpon, V microcarpum*, and *V erythrocarpum*) is a folk remedy that

> has been used for years to relieve UTI symptoms. Cranberry was originally

> thought to work by acidifying the urine, but its effects are now known to

> be due to its interference with the attachment of bacteria to uroepithelial

> cells. In fact, A-type proanthocyanidins were identified in cranberry in

> 1989 as compounds with the potential to inhibit the adherence of

> P-fimbriated *Escherichia coli* to the urogenital mucosa.

>

> Several new studies have been published since the last meta-analysis on

> this issue. Therefore, Dr. Wang and his team wanted to reevaluate the

> effectiveness of cranberry products for preventing UTIs and to study

> factors that influence their effectiveness.

>

> Dr. Wang and colleagues analyzed 10 trials with a total of 1494

> participants (794 in the cranberry groups and 700 in the control groups) in

> the meta-analysis. Significant heterogeneity was found among trials

> (relative risk [RR], 0.68; 95% confidence interval [CI], 0.47 - 1.00; *I* *2

> * = 59%). One trial was excluded from the main analysis because it had the

> most significant effect on the pooled summary estimate.

>

> *Cranberry Products Appear Effective*

>

> Heterogeneity decreased after exclusion of this trial, and

> cranberry-containing products appeared to effectively prevent UTIs (RR,

> 0.62; 95% CI, 0.49 - 0.80; *I* *2* = 43%).

>

> According to sensitivity analysis, the pooled summary estimate was stable

> to risks of bias in random sequence generation, study characteristics, and

> definitions of UTI, but the protective effect was much stronger in 2

> studies that did not use placebo in the control group (pooled RR, 0.36; 95%

> CI, 0.21 - 0.62).

>

> *Certain Populations Seem to Benefit More*

>

> Subgroup analysis found that some populations seemed to experience higher

> protective effects, including women with recurrent UTIs (RR, 0.53; 95% CI,

> 0.33 - 0.83; *I* *2* = 0%), female populations (RR, 0.49; 95% CI, 0.34 -

> 0.73; *I* *2* = 34%), children (RR, 0.33; 95% CI, 0.16 - 0.69; *I* *2* =

> 0%), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72; *I* *2* = 2%),

> and people using cranberry-containing products more than twice daily (RR,

> 0.58; 95% CI, 0.40 - 0.84; *I* *2* = 18%). The findings, though, were not

> statistically significant in meta-regression.

>

> Cranberry juice was more effective than cranberry capsules. The authors

> write that this could be due to increased hydration from drinking the juice

> or the effects of unknown substances in the juice. The authors acknowledge

> that drinking large quantities of juice could be problematic for some

> individuals, including patients with diabetes and those with

> gastrointestinal issues.

>

> A dosing frequency of more than twice daily was more effective. " Because in

> vitro data have suggested that the antiadhesion activity of cranberry juice

> on fimbriated *E coli* lasts for approximately 8 hours after ingestion,

> dosing more frequently than twice daily may be a reasonable choice, " write

> the authors.

>

> *Caution Needed*

>

> " [T]he results of the present meta-analysis support that consumption of

> cranberry-containing products may protect against UTIs in certain

> populations. However, because of the substantial heterogeneity across

> trials, this conclusion should be interpreted with great caution, " the

> authors conclude.

>

> *The authors have disclosed no relevant financial relationships.*

>

> *Arch Intern Med*.

>

2012;172:988-996<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>

> .

> STUDY HIGHLIGHTS

>

> - The investigators systematically searched MEDLINE, EMBASE, and the

> Cochrane Central Register of Controlled Trials from inception to November

> 2011 for randomized controlled trials that compared prevention of UTIs in

> users of cranberry-containing products vs placebo or nonplacebo controls.

> - There were no restrictions for language, population, or publication

> year.

> - 2 authors independently scanned the titles and abstracts of all

> retrieved manuscripts to identify those pertinent to the review.

> - Excluded were abstracts from conferences, proceedings, or clinical

> trial registries.

> - The investigators also manually searched bibliographies of relevant

> studies, reviews, and meta-analyses to identify references that may have

> been missed in the primary search.

> - Prespecified inclusion criteria were randomized controlled trials,

> comparison of cranberry-containing products vs placebo or nonplacebo

> control for prevention of UTI, and outcomes reported as incidence of UTIs.

> - The primary outcome was prespecified as the incidence of UTI, which

> was expressed as either incidence or cumulative incidence rate, depending

> on the original data.

> - The Cochrane risk for bias tool was adopted to assess the risk for

> bias for each trial, which was scored as " high risk, " " low risk, " or

> " unclear. "

> - 13 studies were identified as eligible for qualitative analysis, and

> there were 9 parallel-group and 4 crossover trials.

> - Of the 13 trials, 10 were performed in North America and 3 in Europe..

> - All but 1 of the trials observed participants living in the community.

> - Women with recurrent UTIs, elderly patients, patients with neuropathic

> bladder, pregnant women, and children underwent further subgroup analysis.

> - Administration of cranberry-containing products differed significantly

> in form, daily dosage, A-type proanthocyanidin content, and dosing

> frequency.

> - 9 trials used cranberry juice, and 4 used cranberry capsules or

> tablets.

> - 6 trials used cranberry-containing products provided by a specific

> manufacturer.

> - Daily cranberry dose ranged from 0.4 to 194.4 g.

> - In trials using daily cranberry amounts greater than 10 g, a huge

> range of A-type proanthocyanidins, from 0.838 mg to 224 mg per day, was

> reported.

> - In contrast, those using daily cranberry amounts of less than 10 g did

> not include information about A-type proanthocyanidin content.

> - Cranberry-containing products were administered for 6 months in most

> trials.

> - 10 trials used a formulated placebo, 2 trials did not use a placebo,

> and 1 trial used water as the placebo.

> - 1494 participants across the 10 trials included in the quantitative

> data synthesis, with 794 in the cranberry group and 700 in the control

> group.

> - There was significant heterogeneity among trials.

> - The random-effects pooled RR for cranberry users vs nonusers was 0.62

> (95% CI, 0.49 - 0.80), with a moderate degree of heterogeneity (*I* 2 =

> 43%) after the exclusion of 1 outlier study.

> - A better preventive effect from cranberry-containing products was

> noted with dosing frequency more than twice daily.

> - Subgroup analysis showed that cranberry products seemed to be more

> effective in women with recurrent UTIs (RR, 0.53; 95% CI, 0.33 - 0.83),

> female populations (RR, 0.49; 95% CI, 0.34 - 0.73), children (RR,

> 0.33; 95%

> CI, 0.16 - 0.69), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72),

> and people using cranberry-containing products more than twice daily (RR,

> 0.58; 95% CI, 0.40 - 0.84).

> - The authors concluded that cranberry-containing products were

> associated with a protective effect against UTIs but that the

> result should

> be interpreted in the context of substantial heterogeneity across trials.

>

> CLINICAL IMPLICATIONS

>

> - Use of cranberry products is associated with a reduction in the risk

> for recurrent UTIs.

> - The benefits of cranberry products for UTI prevention are greater in

> women with recurrent UTI, female populations, children, those who drink

> cranberry juice, and those who use the products more than twice daily.

>

July 23, 2012

Quoting Mayhew :

I've heard this = but my mom is allergic to cranberries - she gets an

itchy rash in a day

I've read about other stuff - Clear TRACT for one ... has anyone ever

tried any of these products

Mom (non-LBD) has a chronic UTI and is on continuous low dose

antibiotics - ever other day to keep it down

thanks

DonnaNJ

> From Medscape Education Clinical

> Briefs<http://www.medscape.org/index/list_968_0>Protection

> Against Urinary Tract Infections Seen With Cranberry Products CME/CE

>

> News Author: Troy Brown

> CME Author: Désirée Lie, MD, MSEd

>

> Faculty and Disclosures<http://www.medscape.org/viewarticle/767190?src=cmemp>

>

> CME/CE Released: 07/11/2012; Valid for credit through 07/11/2013

> CME/CE Information

> <http://www.medscape.org/viewarticle/767190?src=cmemp> Earn

> CME/CE Credit

> »<http://www.medscape.org/qna/processor/25609?showStandAlone=true>

> CLINICAL CONTEXT

>

> According to the current study by Wang and colleagues, urinary tract

> infection (UTI) is one of the most commonly acquired bacterial infections,

> and cranberry-containing products have long been used as a folk remedy to

> prevent UTIs. Up to 40% to 50% of women will experience at least 1 episode

> of UTI during their lifetimes. Approximately 20% to 30% of women who have

> had an infection will experience a recurrence. Other groups with an

> increased risk for UTI include pregnant women, elderly patients, and

> patients with neuropathic bladder.

>

> This systematic review and meta-analysis of randomized controlled trials

> determines the efficacy of cranberry products in the prevention of UTIs.

> STUDY SYNOPSIS AND PERSPECTIVE

>

> Cranberry-containing products may protect against UTIs, according to a recent

> meta-analysis<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>.

> However, because there was substantial heterogeneity among the studies, the

> results of the analysis should be viewed with caution, the researchers say.

>

> Chih-Hung Wang, MD, from the Department of Emergency Medicine at National

> Taiwan University Hospital and National Taiwan University College of

> Medicine in Taipei and colleagues report their findings in the July 9 issue

> of the*Archives of Internal Medicine*.

>

> One of the most common bacterial infections, UTIs affect up to 40% to 50%

> of women at least once in their lifetimes, the authors report. Pregnant

> women, the elderly, and patients with neuropathic bladder are also at

> increased risk for developing UTIs.

>

> Cranberry (genus *Vaccinium*, including the species *V oxycoccus, V

> macrocarpon, V microcarpum*, and *V erythrocarpum*) is a folk remedy that

> has been used for years to relieve UTI symptoms. Cranberry was originally

> thought to work by acidifying the urine, but its effects are now known to

> be due to its interference with the attachment of bacteria to uroepithelial

> cells. In fact, A-type proanthocyanidins were identified in cranberry in

> 1989 as compounds with the potential to inhibit the adherence of

> P-fimbriated *Escherichia coli* to the urogenital mucosa.

>

> Several new studies have been published since the last meta-analysis on

> this issue. Therefore, Dr. Wang and his team wanted to reevaluate the

> effectiveness of cranberry products for preventing UTIs and to study

> factors that influence their effectiveness.

>

> Dr. Wang and colleagues analyzed 10 trials with a total of 1494

> participants (794 in the cranberry groups and 700 in the control groups) in

> the meta-analysis. Significant heterogeneity was found among trials

> (relative risk [RR], 0.68; 95% confidence interval [CI], 0.47 - 1.00; *I* *2

> * = 59%). One trial was excluded from the main analysis because it had the

> most significant effect on the pooled summary estimate.

>

> *Cranberry Products Appear Effective*

>

> Heterogeneity decreased after exclusion of this trial, and

> cranberry-containing products appeared to effectively prevent UTIs (RR,

> 0.62; 95% CI, 0.49 - 0.80; *I* *2* = 43%).

>

> According to sensitivity analysis, the pooled summary estimate was stable

> to risks of bias in random sequence generation, study characteristics, and

> definitions of UTI, but the protective effect was much stronger in 2

> studies that did not use placebo in the control group (pooled RR, 0.36; 95%

> CI, 0.21 - 0.62).

>

> *Certain Populations Seem to Benefit More*

>

> Subgroup analysis found that some populations seemed to experience higher

> protective effects, including women with recurrent UTIs (RR, 0.53; 95% CI,

> 0.33 - 0.83; *I* *2* = 0%), female populations (RR, 0.49; 95% CI, 0.34 -

> 0.73; *I* *2* = 34%), children (RR, 0.33; 95% CI, 0.16 - 0.69; *I* *2* =

> 0%), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72; *I* *2* = 2%),

> and people using cranberry-containing products more than twice daily (RR,

> 0.58; 95% CI, 0.40 - 0.84; *I* *2* = 18%). The findings, though, were not

> statistically significant in meta-regression.

>

> Cranberry juice was more effective than cranberry capsules. The authors

> write that this could be due to increased hydration from drinking the juice

> or the effects of unknown substances in the juice. The authors acknowledge

> that drinking large quantities of juice could be problematic for some

> individuals, including patients with diabetes and those with

> gastrointestinal issues.

>

> A dosing frequency of more than twice daily was more effective. " Because in

> vitro data have suggested that the antiadhesion activity of cranberry juice

> on fimbriated *E coli* lasts for approximately 8 hours after ingestion,

> dosing more frequently than twice daily may be a reasonable choice, " write

> the authors.

>

> *Caution Needed*

>

> " [T]he results of the present meta-analysis support that consumption of

> cranberry-containing products may protect against UTIs in certain

> populations. However, because of the substantial heterogeneity across

> trials, this conclusion should be interpreted with great caution, " the

> authors conclude.

>

> *The authors have disclosed no relevant financial relationships.*

>

> *Arch Intern Med*.

>

2012;172:988-996<http://archinte.jamanetwork.com/article.aspx?articleid=1213845>

> .

> STUDY HIGHLIGHTS

>

> - The investigators systematically searched MEDLINE, EMBASE, and the

> Cochrane Central Register of Controlled Trials from inception to November

> 2011 for randomized controlled trials that compared prevention of UTIs in

> users of cranberry-containing products vs placebo or nonplacebo controls.

> - There were no restrictions for language, population, or publication

> year.

> - 2 authors independently scanned the titles and abstracts of all

> retrieved manuscripts to identify those pertinent to the review.

> - Excluded were abstracts from conferences, proceedings, or clinical

> trial registries.

> - The investigators also manually searched bibliographies of relevant

> studies, reviews, and meta-analyses to identify references that may have

> been missed in the primary search.

> - Prespecified inclusion criteria were randomized controlled trials,

> comparison of cranberry-containing products vs placebo or nonplacebo

> control for prevention of UTI, and outcomes reported as incidence of UTIs.

> - The primary outcome was prespecified as the incidence of UTI, which

> was expressed as either incidence or cumulative incidence rate, depending

> on the original data.

> - The Cochrane risk for bias tool was adopted to assess the risk for

> bias for each trial, which was scored as " high risk, " " low risk, " or

> " unclear. "

> - 13 studies were identified as eligible for qualitative analysis, and

> there were 9 parallel-group and 4 crossover trials.

> - Of the 13 trials, 10 were performed in North America and 3 in Europe..

> - All but 1 of the trials observed participants living in the community.

> - Women with recurrent UTIs, elderly patients, patients with neuropathic

> bladder, pregnant women, and children underwent further subgroup analysis.

> - Administration of cranberry-containing products differed significantly

> in form, daily dosage, A-type proanthocyanidin content, and dosing

> frequency.

> - 9 trials used cranberry juice, and 4 used cranberry capsules or

> tablets.

> - 6 trials used cranberry-containing products provided by a specific

> manufacturer.

> - Daily cranberry dose ranged from 0.4 to 194.4 g.

> - In trials using daily cranberry amounts greater than 10 g, a huge

> range of A-type proanthocyanidins, from 0.838 mg to 224 mg per day, was

> reported.

> - In contrast, those using daily cranberry amounts of less than 10 g did

> not include information about A-type proanthocyanidin content.

> - Cranberry-containing products were administered for 6 months in most

> trials.

> - 10 trials used a formulated placebo, 2 trials did not use a placebo,

> and 1 trial used water as the placebo.

> - 1494 participants across the 10 trials included in the quantitative

> data synthesis, with 794 in the cranberry group and 700 in the control

> group.

> - There was significant heterogeneity among trials.

> - The random-effects pooled RR for cranberry users vs nonusers was 0.62

> (95% CI, 0.49 - 0.80), with a moderate degree of heterogeneity (*I* 2 =

> 43%) after the exclusion of 1 outlier study.

> - A better preventive effect from cranberry-containing products was

> noted with dosing frequency more than twice daily.

> - Subgroup analysis showed that cranberry products seemed to be more

> effective in women with recurrent UTIs (RR, 0.53; 95% CI, 0.33 - 0.83),

> female populations (RR, 0.49; 95% CI, 0.34 - 0.73), children (RR,

> 0.33; 95%

> CI, 0.16 - 0.69), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72),

> and people using cranberry-containing products more than twice daily (RR,

> 0.58; 95% CI, 0.40 - 0.84).

> - The authors concluded that cranberry-containing products were

> associated with a protective effect against UTIs but that the

> result should

> be interpreted in the context of substantial heterogeneity across trials.

>

> CLINICAL IMPLICATIONS

>

> - Use of cranberry products is associated with a reduction in the risk

> for recurrent UTIs.

> - The benefits of cranberry products for UTI prevention are greater in

> women with recurrent UTI, female populations, children, those who drink

> cranberry juice, and those who use the products more than twice daily.

>

July 24, 2012

I have a family member who is a dietitian, so I asked her about cranberries

and UTIs. Here's what she told me:

The theory is the acidic nature of cranberries help prevent UTI. I would

believe that other acidic beverages can help. Actually just drinking lots

of water can help. If you google UTI there should be some answers.

I hope this helps.

Kate

> **

>

> Quoting Mayhew :

>

> I've heard this = but my mom is allergic to cranberries - she gets an

> itchy rash in a day

>

> I've read about other stuff - Clear TRACT for one ... has anyone ever

> tried any of these products

>

> Mom (non-LBD) has a chronic UTI and is on continuous low dose

> antibiotics - ever other day to keep it down

>

> thanks

>

> DonnaNJ

>

> > From Medscape Education Clinical

> > Briefs<http://www.medscape.org/index/list_968_0>Protection

> > Against Urinary Tract Infections Seen With Cranberry Products CME/CE

> >

> > News Author: Troy Brown

> > CME Author: Désirée Lie, MD, MSEd

> >

> > Faculty and Disclosures<

> http://www.medscape.org/viewarticle/767190?src=cmemp>

> >

> > CME/CE Released: 07/11/2012; Valid for credit through 07/11/2013

> > CME/CE Information

> > <http://www.medscape.org/viewarticle/767190?src=cmemp> Earn

> > CME/CE Credit

> > »<http://www.medscape.org/qna/processor/25609?showStandAlone=true>

> > CLINICAL CONTEXT

> >

> > According to the current study by Wang and colleagues, urinary tract

> > infection (UTI) is one of the most commonly acquired bacterial

> infections,

> > and cranberry-containing products have long been used as a folk remedy to

> > prevent UTIs. Up to 40% to 50% of women will experience at least 1

> episode

> > of UTI during their lifetimes. Approximately 20% to 30% of women who have

> > had an infection will experience a recurrence. Other groups with an

> > increased risk for UTI include pregnant women, elderly patients, and

> > patients with neuropathic bladder.

> >

> > This systematic review and meta-analysis of randomized controlled trials

> > determines the efficacy of cranberry products in the prevention of UTIs.

> > STUDY SYNOPSIS AND PERSPECTIVE

> >

> > Cranberry-containing products may protect against UTIs, according to a

> recent

> > meta-analysis<

> http://archinte.jamanetwork.com/article.aspx?articleid=1213845>.

> > However, because there was substantial heterogeneity among the studies,

> the

> > results of the analysis should be viewed with caution, the researchers

> say.

> >

> > Chih-Hung Wang, MD, from the Department of Emergency Medicine at National

> > Taiwan University Hospital and National Taiwan University College of

> > Medicine in Taipei and colleagues report their findings in the July 9

> issue

> > of the*Archives of Internal Medicine*.

> >

> > One of the most common bacterial infections, UTIs affect up to 40% to 50%

> > of women at least once in their lifetimes, the authors report. Pregnant

> > women, the elderly, and patients with neuropathic bladder are also at

> > increased risk for developing UTIs.

> >

> > Cranberry (genus *Vaccinium*, including the species *V oxycoccus, V

> > macrocarpon, V microcarpum*, and *V erythrocarpum*) is a folk remedy that

> > has been used for years to relieve UTI symptoms. Cranberry was originally

> > thought to work by acidifying the urine, but its effects are now known to

> > be due to its interference with the attachment of bacteria to

> uroepithelial

> > cells. In fact, A-type proanthocyanidins were identified in cranberry in

> > 1989 as compounds with the potential to inhibit the adherence of

> > P-fimbriated *Escherichia coli* to the urogenital mucosa.

> >

> > Several new studies have been published since the last meta-analysis on

> > this issue. Therefore, Dr. Wang and his team wanted to reevaluate the

> > effectiveness of cranberry products for preventing UTIs and to study

> > factors that influence their effectiveness.

> >

> > Dr. Wang and colleagues analyzed 10 trials with a total of 1494

> > participants (794 in the cranberry groups and 700 in the control groups)

> in

> > the meta-analysis. Significant heterogeneity was found among trials

> > (relative risk [RR], 0.68; 95% confidence interval [CI], 0.47 - 1.00;

> *I* *2

> > * = 59%). One trial was excluded from the main analysis because it had

> the

> > most significant effect on the pooled summary estimate.

> >

> > *Cranberry Products Appear Effective*

> >

> > Heterogeneity decreased after exclusion of this trial, and

> > cranberry-containing products appeared to effectively prevent UTIs (RR,

> > 0.62; 95% CI, 0.49 - 0.80; *I* *2* = 43%).

> >

> > According to sensitivity analysis, the pooled summary estimate was stable

> > to risks of bias in random sequence generation, study characteristics,

> and

> > definitions of UTI, but the protective effect was much stronger in 2

> > studies that did not use placebo in the control group (pooled RR, 0.36;

> 95%

> > CI, 0.21 - 0.62).

> >

> > *Certain Populations Seem to Benefit More*

> >

> > Subgroup analysis found that some populations seemed to experience higher

> > protective effects, including women with recurrent UTIs (RR, 0.53; 95%

> CI,

> > 0.33 - 0.83; *I* *2* = 0%), female populations (RR, 0.49; 95% CI, 0.34 -

> > 0.73; *I* *2* = 34%), children (RR, 0.33; 95% CI, 0.16 - 0.69; *I* *2* =

> > 0%), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72; *I* *2* = 2%),

> > and people using cranberry-containing products more than twice daily (RR,

> > 0.58; 95% CI, 0.40 - 0.84; *I* *2* = 18%). The findings, though, were not

> > statistically significant in meta-regression.

> >

> > Cranberry juice was more effective than cranberry capsules. The authors

> > write that this could be due to increased hydration from drinking the

> juice

> > or the effects of unknown substances in the juice. The authors

> acknowledge

> > that drinking large quantities of juice could be problematic for some

> > individuals, including patients with diabetes and those with

> > gastrointestinal issues.

> >

> > A dosing frequency of more than twice daily was more effective. " Because

> in

> > vitro data have suggested that the antiadhesion activity of cranberry

> juice

> > on fimbriated *E coli* lasts for approximately 8 hours after ingestion,

> > dosing more frequently than twice daily may be a reasonable choice, "

> write

> > the authors.

> >

> > *Caution Needed*

> >

> > " [T]he results of the present meta-analysis support that consumption of

> > cranberry-containing products may protect against UTIs in certain

> > populations. However, because of the substantial heterogeneity across

> > trials, this conclusion should be interpreted with great caution, " the

> > authors conclude.

> >

> > *The authors have disclosed no relevant financial relationships.*

> >

> > *Arch Intern Med*.

> > 2012;172:988-996<

> http://archinte.jamanetwork.com/article.aspx?articleid=1213845>

> > .

> > STUDY HIGHLIGHTS

> >

> > - The investigators systematically searched MEDLINE, EMBASE, and the

> > Cochrane Central Register of Controlled Trials from inception to November

> > 2011 for randomized controlled trials that compared prevention of UTIs in

> > users of cranberry-containing products vs placebo or nonplacebo controls.

> > - There were no restrictions for language, population, or publication

> > year.

> > - 2 authors independently scanned the titles and abstracts of all

> > retrieved manuscripts to identify those pertinent to the review.

> > - Excluded were abstracts from conferences, proceedings, or clinical

> > trial registries.

> > - The investigators also manually searched bibliographies of relevant

> > studies, reviews, and meta-analyses to identify references that may have

> > been missed in the primary search.

> > - Prespecified inclusion criteria were randomized controlled trials,

> > comparison of cranberry-containing products vs placebo or nonplacebo

> > control for prevention of UTI, and outcomes reported as incidence of

> UTIs.

> > - The primary outcome was prespecified as the incidence of UTI, which

> > was expressed as either incidence or cumulative incidence rate, depending

> > on the original data.

> > - The Cochrane risk for bias tool was adopted to assess the risk for

> > bias for each trial, which was scored as " high risk, " " low risk, " or

> > " unclear. "

> > - 13 studies were identified as eligible for qualitative analysis, and

> > there were 9 parallel-group and 4 crossover trials.

> > - Of the 13 trials, 10 were performed in North America and 3 in Europe..

>

> > - All but 1 of the trials observed participants living in the community.

> > - Women with recurrent UTIs, elderly patients, patients with neuropathic

> > bladder, pregnant women, and children underwent further subgroup

> analysis.

> > - Administration of cranberry-containing products differed significantly

> > in form, daily dosage, A-type proanthocyanidin content, and dosing

> > frequency.

> > - 9 trials used cranberry juice, and 4 used cranberry capsules or

> > tablets.

> > - 6 trials used cranberry-containing products provided by a specific

> > manufacturer.

> > - Daily cranberry dose ranged from 0.4 to 194.4 g.

> > - In trials using daily cranberry amounts greater than 10 g, a huge

> > range of A-type proanthocyanidins, from 0.838 mg to 224 mg per day, was

> > reported.

> > - In contrast, those using daily cranberry amounts of less than 10 g did

> > not include information about A-type proanthocyanidin content.

> > - Cranberry-containing products were administered for 6 months in most

> > trials.

> > - 10 trials used a formulated placebo, 2 trials did not use a placebo,

> > and 1 trial used water as the placebo.

> > - 1494 participants across the 10 trials included in the quantitative

> > data synthesis, with 794 in the cranberry group and 700 in the control

> > group.

> > - There was significant heterogeneity among trials.

> > - The random-effects pooled RR for cranberry users vs nonusers was 0.62

> > (95% CI, 0.49 - 0.80), with a moderate degree of heterogeneity (*I* 2 =

> > 43%) after the exclusion of 1 outlier study.

> > - A better preventive effect from cranberry-containing products was

> > noted with dosing frequency more than twice daily.

> > - Subgroup analysis showed that cranberry products seemed to be more

> > effective in women with recurrent UTIs (RR, 0.53; 95% CI, 0.33 - 0.83),

> > female populations (RR, 0.49; 95% CI, 0.34 - 0.73), children (RR,

> > 0.33; 95%

> > CI, 0.16 - 0.69), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72),

> > and people using cranberry-containing products more than twice daily (RR,

> > 0.58; 95% CI, 0.40 - 0.84).

> > - The authors concluded that cranberry-containing products were

> > associated with a protective effect against UTIs but that the

> > result should

> > be interpreted in the context of substantial heterogeneity across trials.

> >

> > CLINICAL IMPLICATIONS

> >

> > - Use of cranberry products is associated with a reduction in the risk

> > for recurrent UTIs.

> > - The benefits of cranberry products for UTI prevention are greater in

> > women with recurrent UTI, female populations, children, those who drink

> > cranberry juice, and those who use the products more than twice daily.

> >

July 24, 2012

I have a family member who is a dietitian, so I asked her about cranberries

and UTIs. Here's what she told me:

The theory is the acidic nature of cranberries help prevent UTI. I would

believe that other acidic beverages can help. Actually just drinking lots

of water can help. If you google UTI there should be some answers.

I hope this helps.

Kate

> **

>

> Quoting Mayhew :

>

> I've heard this = but my mom is allergic to cranberries - she gets an

> itchy rash in a day

>

> I've read about other stuff - Clear TRACT for one ... has anyone ever

> tried any of these products

>

> Mom (non-LBD) has a chronic UTI and is on continuous low dose

> antibiotics - ever other day to keep it down

>

> thanks

>

> DonnaNJ

>

> > From Medscape Education Clinical

> > Briefs<http://www.medscape.org/index/list_968_0>Protection

> > Against Urinary Tract Infections Seen With Cranberry Products CME/CE

> >

> > News Author: Troy Brown

> > CME Author: Désirée Lie, MD, MSEd

> >

> > Faculty and Disclosures<

> http://www.medscape.org/viewarticle/767190?src=cmemp>

> >

> > CME/CE Released: 07/11/2012; Valid for credit through 07/11/2013

> > CME/CE Information

> > <http://www.medscape.org/viewarticle/767190?src=cmemp> Earn

> > CME/CE Credit

> > »<http://www.medscape.org/qna/processor/25609?showStandAlone=true>

> > CLINICAL CONTEXT

> >

> > According to the current study by Wang and colleagues, urinary tract

> > infection (UTI) is one of the most commonly acquired bacterial

> infections,

> > and cranberry-containing products have long been used as a folk remedy to

> > prevent UTIs. Up to 40% to 50% of women will experience at least 1

> episode

> > of UTI during their lifetimes. Approximately 20% to 30% of women who have

> > had an infection will experience a recurrence. Other groups with an

> > increased risk for UTI include pregnant women, elderly patients, and

> > patients with neuropathic bladder.

> >

> > This systematic review and meta-analysis of randomized controlled trials

> > determines the efficacy of cranberry products in the prevention of UTIs.

> > STUDY SYNOPSIS AND PERSPECTIVE

> >

> > Cranberry-containing products may protect against UTIs, according to a

> recent

> > meta-analysis<

> http://archinte.jamanetwork.com/article.aspx?articleid=1213845>.

> > However, because there was substantial heterogeneity among the studies,

> the

> > results of the analysis should be viewed with caution, the researchers

> say.

> >

> > Chih-Hung Wang, MD, from the Department of Emergency Medicine at National

> > Taiwan University Hospital and National Taiwan University College of

> > Medicine in Taipei and colleagues report their findings in the July 9

> issue

> > of the*Archives of Internal Medicine*.

> >

> > One of the most common bacterial infections, UTIs affect up to 40% to 50%

> > of women at least once in their lifetimes, the authors report. Pregnant

> > women, the elderly, and patients with neuropathic bladder are also at

> > increased risk for developing UTIs.

> >

> > Cranberry (genus *Vaccinium*, including the species *V oxycoccus, V

> > macrocarpon, V microcarpum*, and *V erythrocarpum*) is a folk remedy that

> > has been used for years to relieve UTI symptoms. Cranberry was originally

> > thought to work by acidifying the urine, but its effects are now known to

> > be due to its interference with the attachment of bacteria to

> uroepithelial

> > cells. In fact, A-type proanthocyanidins were identified in cranberry in

> > 1989 as compounds with the potential to inhibit the adherence of

> > P-fimbriated *Escherichia coli* to the urogenital mucosa.

> >

> > Several new studies have been published since the last meta-analysis on

> > this issue. Therefore, Dr. Wang and his team wanted to reevaluate the

> > effectiveness of cranberry products for preventing UTIs and to study

> > factors that influence their effectiveness.

> >

> > Dr. Wang and colleagues analyzed 10 trials with a total of 1494

> > participants (794 in the cranberry groups and 700 in the control groups)

> in

> > the meta-analysis. Significant heterogeneity was found among trials

> > (relative risk [RR], 0.68; 95% confidence interval [CI], 0.47 - 1.00;

> *I* *2

> > * = 59%). One trial was excluded from the main analysis because it had

> the

> > most significant effect on the pooled summary estimate.

> >

> > *Cranberry Products Appear Effective*

> >

> > Heterogeneity decreased after exclusion of this trial, and

> > cranberry-containing products appeared to effectively prevent UTIs (RR,

> > 0.62; 95% CI, 0.49 - 0.80; *I* *2* = 43%).

> >

> > According to sensitivity analysis, the pooled summary estimate was stable

> > to risks of bias in random sequence generation, study characteristics,

> and

> > definitions of UTI, but the protective effect was much stronger in 2

> > studies that did not use placebo in the control group (pooled RR, 0.36;

> 95%

> > CI, 0.21 - 0.62).

> >

> > *Certain Populations Seem to Benefit More*

> >

> > Subgroup analysis found that some populations seemed to experience higher

> > protective effects, including women with recurrent UTIs (RR, 0.53; 95%

> CI,

> > 0.33 - 0.83; *I* *2* = 0%), female populations (RR, 0.49; 95% CI, 0.34 -

> > 0.73; *I* *2* = 34%), children (RR, 0.33; 95% CI, 0.16 - 0.69; *I* *2* =

> > 0%), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72; *I* *2* = 2%),

> > and people using cranberry-containing products more than twice daily (RR,

> > 0.58; 95% CI, 0.40 - 0.84; *I* *2* = 18%). The findings, though, were not

> > statistically significant in meta-regression.

> >

> > Cranberry juice was more effective than cranberry capsules. The authors

> > write that this could be due to increased hydration from drinking the

> juice

> > or the effects of unknown substances in the juice. The authors

> acknowledge

> > that drinking large quantities of juice could be problematic for some

> > individuals, including patients with diabetes and those with

> > gastrointestinal issues.

> >

> > A dosing frequency of more than twice daily was more effective. " Because

> in

> > vitro data have suggested that the antiadhesion activity of cranberry

> juice

> > on fimbriated *E coli* lasts for approximately 8 hours after ingestion,

> > dosing more frequently than twice daily may be a reasonable choice, "

> write

> > the authors.

> >

> > *Caution Needed*

> >

> > " [T]he results of the present meta-analysis support that consumption of

> > cranberry-containing products may protect against UTIs in certain

> > populations. However, because of the substantial heterogeneity across

> > trials, this conclusion should be interpreted with great caution, " the

> > authors conclude.

> >

> > *The authors have disclosed no relevant financial relationships.*

> >

> > *Arch Intern Med*.

> > 2012;172:988-996<

> http://archinte.jamanetwork.com/article.aspx?articleid=1213845>

> > .

> > STUDY HIGHLIGHTS

> >

> > - The investigators systematically searched MEDLINE, EMBASE, and the

> > Cochrane Central Register of Controlled Trials from inception to November

> > 2011 for randomized controlled trials that compared prevention of UTIs in

> > users of cranberry-containing products vs placebo or nonplacebo controls.

> > - There were no restrictions for language, population, or publication

> > year.

> > - 2 authors independently scanned the titles and abstracts of all

> > retrieved manuscripts to identify those pertinent to the review.

> > - Excluded were abstracts from conferences, proceedings, or clinical

> > trial registries.

> > - The investigators also manually searched bibliographies of relevant

> > studies, reviews, and meta-analyses to identify references that may have

> > been missed in the primary search.

> > - Prespecified inclusion criteria were randomized controlled trials,

> > comparison of cranberry-containing products vs placebo or nonplacebo

> > control for prevention of UTI, and outcomes reported as incidence of

> UTIs.

> > - The primary outcome was prespecified as the incidence of UTI, which

> > was expressed as either incidence or cumulative incidence rate, depending

> > on the original data.

> > - The Cochrane risk for bias tool was adopted to assess the risk for

> > bias for each trial, which was scored as " high risk, " " low risk, " or

> > " unclear. "

> > - 13 studies were identified as eligible for qualitative analysis, and

> > there were 9 parallel-group and 4 crossover trials.

> > - Of the 13 trials, 10 were performed in North America and 3 in Europe..

>

> > - All but 1 of the trials observed participants living in the community.

> > - Women with recurrent UTIs, elderly patients, patients with neuropathic

> > bladder, pregnant women, and children underwent further subgroup

> analysis.

> > - Administration of cranberry-containing products differed significantly

> > in form, daily dosage, A-type proanthocyanidin content, and dosing

> > frequency.

> > - 9 trials used cranberry juice, and 4 used cranberry capsules or

> > tablets.

> > - 6 trials used cranberry-containing products provided by a specific

> > manufacturer.

> > - Daily cranberry dose ranged from 0.4 to 194.4 g.

> > - In trials using daily cranberry amounts greater than 10 g, a huge

> > range of A-type proanthocyanidins, from 0.838 mg to 224 mg per day, was

> > reported.

> > - In contrast, those using daily cranberry amounts of less than 10 g did

> > not include information about A-type proanthocyanidin content.

> > - Cranberry-containing products were administered for 6 months in most

> > trials.

> > - 10 trials used a formulated placebo, 2 trials did not use a placebo,

> > and 1 trial used water as the placebo.

> > - 1494 participants across the 10 trials included in the quantitative

> > data synthesis, with 794 in the cranberry group and 700 in the control

> > group.

> > - There was significant heterogeneity among trials.

> > - The random-effects pooled RR for cranberry users vs nonusers was 0.62

> > (95% CI, 0.49 - 0.80), with a moderate degree of heterogeneity (*I* 2 =

> > 43%) after the exclusion of 1 outlier study.

> > - A better preventive effect from cranberry-containing products was

> > noted with dosing frequency more than twice daily.

> > - Subgroup analysis showed that cranberry products seemed to be more

> > effective in women with recurrent UTIs (RR, 0.53; 95% CI, 0.33 - 0.83),

> > female populations (RR, 0.49; 95% CI, 0.34 - 0.73), children (RR,

> > 0.33; 95%

> > CI, 0.16 - 0.69), cranberry juice users (RR, 0.47; 95% CI, 0.30 - 0.72),

> > and people using cranberry-containing products more than twice daily (RR,

> > 0.58; 95% CI, 0.40 - 0.84).

> > - The authors concluded that cranberry-containing products were

> > associated with a protective effect against UTIs but that the

> > result should

> > be interpreted in the context of substantial heterogeneity across trials.

> >

> > CLINICAL IMPLICATIONS

> >

> > - Use of cranberry products is associated with a reduction in the risk

> > for recurrent UTIs.

> > - The benefits of cranberry products for UTI prevention are greater in

> > women with recurrent UTI, female populations, children, those who drink

> > cranberry juice, and those who use the products more than twice daily.

> >

July 24, 2012

The Urolgists I worked with for years reminded our patients to drink 100%

cranberry juice to be effective. I believe the pH changes when it is mixed with

other fruits. I'm allergic to the antibiotics usually used for UTIs so figure

this can't hurt. I can't speak for anyone else but Diet Ocean Spray goes down

really easy for me. Hope this is useful info.

July 24, 2012

We used D-Manose it comes as a liquid at Whole Foods, etc .and also online.

Theory is It binds e choli bacteria and prevents from attaching to wall of

bladder. That is the theory and indicated by at least 2 studies. More needs to

be done to determine if it really does work and if there are other bacteria it

works with - however it worked for one members mother and si we tried it and it

appears it also worked for my mil.

I always insisted on a culture and sensitivity test w uti's do precious time was

not wasted. She went through a rash of e choli uti's and after adding the

d-manose she did not have a uti for about a year and that one she got was

psuedamonas not e-choli.

Every uti she was losing ground and we decided to try and see. D-manose is

very sweet and thick it can be mixed into any liquid - coffee tea juice water.

We initially followed directions then cut back to a maintenance level as uts

expensive about $30 a bottle. We were also giving her nature's bounty cranberry

capsules 1 3x a day on advice of her doctor " it's not possible to drink enough

cranberry juice to reach effective levels " .

Also pushing water - that was very hard she did not want to drink as she had

early on decided it was too much trouble to drink liquids and have to go to the

bathroom - she decided that long before official diagnosis. She even convinced

her doctor that she had an over active bladder and was prescribed dritripan!

Luckily I found out within a week when she became dehydrated and put a stop to

that with another trip to her doctor that I made time to go to with her. (she

did not like me going) Her poor doctor asked if she was going too often and she

emphatically said yes far too often. He was clearly thinking of how else to

approach this when I asked how many times a day she had to go and she answered

" it's terrible 2 or three times a day! " . I asked if that included night time.

" oh yes it's just terrible " . Doc quickly recovered his shock and asked what did

she drink during the day she answered one cup of coffee in the morning. Her doc

gave me one of those " Ohh " looks and told her he was stopping the bladder med

and she had to drink of glasses of water and juice each day. She was not happy

but she would comply if I was monitoring. I wish I had pushed for a referral

then for a neural evaluation but I believed what we were told about old age etc.

We sure know what was going on now...

Sorry to ramble so - it was certainly an issue I dealt with and triaged for each

and every day with increasing ramifications and challenges. I wish you every

bit of luck with this. You can only do your best so don't let it get to you.

If she won't drink enough people can try referring to doctor's orders, what

consequences are, rewards or bribes. If she's allergic not much ti do w that

unless doc thinks safe to try with Claritin or Zyrtec (both safe with LBD).

preventatives like antibiotic and/or d-manose will also help but there's only so

much to do - and currently these things are pretty good. Early on I did have to

coach her about wiping as she was not having good practice in that area I stood

by patiently for her to let me know she was through then told her which way (she

truly could not remember or distinguish up or down). Depending on what

condition she is in there may be little things like that to help. Good hygiene

is extremely helpful important.

Hope this helps. I am indebted to who went through similar with her mother

and offered me a lot of encouragement and suggestions as I was trying to make

sure I was doing all I could.

- Dorothy

from cell phone

> I have a family member who is a dietitian, so I asked her about cranberries

> and UTIs. Here's what she told me:

>

> The theory is the acidic nature of cranberries help prevent UTI. I would

> believe that other acidic beverages can help. Actually just drinking lots

> of water can help. If you google UTI there should be some answers.

>

> I hope this helps.

>

> Kate

>

>> **

>>

>> Quoting Mayhew :

>>

>> I've heard this = but my mom is allergic to cranberries - she gets an

>> itchy rash in a day

>>

>> I've read about other stuff - Clear TRACT for one ... has anyone ever

>> tried any of these products

>>

>> Mom (non-LBD) has a chronic UTI and is on continuous low dose

>> antibiotics - ever other day to keep it down

>>

>> thanks

>>

>> DonnaNJ

>>

>>> From Medscape Education Clinical

>>> Briefs<http://www.medscape.org/index/list_968_0>Protection

>>> Against Urinary Tract Infections Seen With Cranberry Products CME/CE

>>>

>>> News Author: Troy Brown

>>> CME Author: Dï¿½sirï¿½e Lie, MD, MSEd

>>>

July 24, 2012