Why d-Mannose May Be as Efficient as Antibiotics in the Treatment of Acute Uncomplicated Lower Urinary Tract Infections—Preliminary Considerations and Conclusions from a Non-Interventional Study
Abstract
:1. Epidemiology and Infectiology of Acute Uncomplicated Urinary Tract Infections
2. Antibiotics as Current Standard Therapy and Relevance of Resistance Development
3. Fundamental Aspects of the d-Mannose Mode of Action
4. Clinical Data for d-Mannose in UTI
5. Clinical Diagnosis and Assessment of Treatment Efficacy in UTIs with a Validated Measuring Instrument
6. Post Hoc Analysis of the Potential Efficacy of d-Mannose in the Treatment of Acute Episodes of UTI
6.1. Clinical Efficacy of d-Mannose in the Treatment of Acute UTI—A Non-Interventional Study
6.2. Transfer of Clinical Data of the NIS to the ACSS as a Validated Instrument
6.3. Estimated Cure Rates from Reanalysis of the NIS with d-Mannose Treatment for Acute UTI
7. Cure Rates of Controlled Trials—Antibiotic Treatment of Acute UTI
8. Time-Dependent Changes of Symptoms in AUC Patients Treated with d-Mannose or Antibiotics
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Symptom | Original Assessment | Rules for Transfer to ACSS “Typical Domain” |
---|---|---|
Urination frequency | 0–3 | 0–3 (no adaptation necessary) |
Urination urgency | No, yes | No ⇒ 0; yes ⇒ 2 |
Urination burning/pain (rated twice) | 0–5 | 0 ⇒ 0; 1 ⇒ 1; 2, 3 ⇒ 2; 4, 5 ⇒ 3 |
Incomplete bladder emptying | No, yes | No ⇒ 0; yes ⇒ 2 |
Visible blood in urine | No, yes | No ⇒ 0; yes ⇒ 2 |
Group 1: d-Mannose Monotherapy (n = 23) | Group 2: d-Mannose and Other Measures (n = 36) | |||||
---|---|---|---|---|---|---|
Day | aACSS-TD (Median) | Cure Rate 1 | Cure Rate 2 | aACSS-TD (Median) | Cure Rate 1 | Cure Rate 2 |
0 | 9.0 | - | - | 10.0 | - | - |
1 | 9.0 | 4.4% | 4.4% | 9.5 | 5.6% | 2.8% |
2 | 4.0 | 52.2% | 4.4% | 6.5 | 38.9% | 5.6% |
3 | 2.0 | 73.9% | 56.5% | 3.0 | 61.1% | 41.7% |
4 | 0.0 | 91.3% | 82.6% | 1.0 | 80.6% | 61.1% |
5 | 0.0 | 91.3% | 82.6% | 2.0 | 80.6% | 66.7% |
6 | 0.0 | 91.3% | 87.0% | 0.5 | 86.1% | 77.8% |
7 | 0.0 | 91.3% | 87.0% | 0.0 | 86.1% | 77.8% |
Cure rate [95% CI] on day 7 | - | 91.3% [72–99%] | 87.0% [66–97%] | - | 86.1% [71–95%] | 77.8% [61–90%] |
Treatment [Reference] | Baseline | Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | Day 6 | Day 7–8 |
---|---|---|---|---|---|---|---|---|
d-mannose monotherapy 1 | 51.7 | 46.9 | 28.5 | 14.5 | 5.6 | 8.3 | 11.1 | 0 |
d-mannose and other measures 1 | 54.5 | 50.9 | 35.9 | 21.9 | 13.9 | 13.6 | 13.3 | 3.2 |
Fosfomycin (single dose) 1 [38] | 56.1 | - | - | 25.0 | - | - | - | 11.7 |
Fosfomycin (single dose) 2 [47] | 50.8 | 26.7 | 16.7 | 10.0 | 8.3 | 7.5 | 5.8 | 4.2 |
Pivmecillinam (5 days) 3 [52] | 42.6 | 26.7 | 14.0 | 12.0 | 8.0 | 7.3 | 7.3 | 6.7 |
Pivmecillinam (3 days) 1 [49] | 68.3 | 41.7 | 22.2 | 13.9 | 5.6 | 5.0 | 3.9 | - |
Ciprofloxacin (3 days) 4 [50] | 48.3 | - | - | - | 10.8 | - | - | 5.0 |
Ciprofloxacin (5 days) 3 [51] | 50.7 | - | - | - | - | - | - | 10.0 |
Norfloxacin (3 days) 5 [48] | 46.0 | - | - | 11.6 | - | - | - | 4.0% |
Summary of antibiotic treatment (median) | 50.7 | 26.7 | 16.7 | 12.0 | 8.2 | 7.3 | 5.8 | 5.0 |
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Wagenlehner, F.; Lorenz, H.; Ewald, O.; Gerke, P. Why d-Mannose May Be as Efficient as Antibiotics in the Treatment of Acute Uncomplicated Lower Urinary Tract Infections—Preliminary Considerations and Conclusions from a Non-Interventional Study. Antibiotics 2022, 11, 314. https://doi.org/10.3390/antibiotics11030314
Wagenlehner F, Lorenz H, Ewald O, Gerke P. Why d-Mannose May Be as Efficient as Antibiotics in the Treatment of Acute Uncomplicated Lower Urinary Tract Infections—Preliminary Considerations and Conclusions from a Non-Interventional Study. Antibiotics. 2022; 11(3):314. https://doi.org/10.3390/antibiotics11030314
Chicago/Turabian StyleWagenlehner, Florian, Horst Lorenz, Oda Ewald, and Peter Gerke. 2022. "Why d-Mannose May Be as Efficient as Antibiotics in the Treatment of Acute Uncomplicated Lower Urinary Tract Infections—Preliminary Considerations and Conclusions from a Non-Interventional Study" Antibiotics 11, no. 3: 314. https://doi.org/10.3390/antibiotics11030314