Cranberry Extract Versus D-Mannose in Reducing Recurrent Urinary Tract Infection: A Retrospective Cohort Study at a Tertiary Care Centre.

Background: Recurrent urinary tract infection (rUTI) affects 25–30% of women following an index episode and poses a growing challenge amid escalating antimicrobial resistance. Non-antibiotic prophylactic agents are urgently needed. Cranberry extract and D-mannose have biological plausibility but have not been compared head-to-head in an adequately powered Indian cohort. Objective: To compare the efficacy and safety of standardised cranberry extract (proanthocyanidin [PAC] 36 mg/day) with D-mannose (2 g/day) versus standard care in preventing rUTI over 12 months, based on retrospective review of clinical records. Study Design: Retrospective cohort study conducted using medical records from a tertiary care teaching hospital in Lucknow, India. Results: At 12 months, there was no difference between Groups A and B; recurrence was lower in Groups A (24.5%) and B (27.3%) compared to C (57.6%; p<0.001); time-to-recurrence was longer in A (214 d) and B (197 d) compared to C (112 d). The CFU reduction was highest in A (1.8 log₁¹) compared to B (1.5) and C (0.4), and both treatments were well tolerated with no significant side effects. Conclusion: Cranberry extract, standardised to PAC 36 mg/day, and D-mannose 2 g/day are associated with significantly reduced rUTI recurrence compared with standard care and represent effective, resistance-sparing prophylactic options. Cranberry extract demonstrated slightly better bacteriological results, but clinical recurrence rates were similar between the active groups. These data support use of either agent as a non-antibiotic first-line prophylaxis in uncomplicated rUTI.