Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

Laura Levy, DHSc, PA-C


Objective: The objective of this selective EBM review is to determine whether or not are D-mannose pills an effective form of prophylaxis for women prone to recurrent urinary tract infections?

Study Design: Systematic review of three randomized controlled trials (RCTs) published between 2014-2016, all in the English language.

Data Sources: Three randomized controlled trials (RCTs) which evaluated the effectiveness of D-mannose as prophylaxis against recurrent UTI in women as compared to control groups either given no prophylaxis and or antibiotic prophylaxis. All studies were found using PubMed and the Cochrane library.

Outcomes Measured: All three studies measured the number of patients that had a recurrent UTI during the follow-up period. One study also measured the time to recurrence of UTI and change in pain and urgency symptoms on the visual analog scale (VAS).

Results: All three studies found that patients were significantly less likely to have a UTI recurrence with D-mannose compared to no agents for prophylaxis. One study found similar efficacy of D-mannose and nitrofurantoin for prophylaxis; however, tolerability of D-mannose was significantly better than that of nitrofurantoin. A third study found that D-mannose prevented urinary tract infections better than trimethoprim-sulfamethoxazole (TMP-SMX), however, dosing of TMP-SMX was suboptimal.

Conclusions: D-mannose was found to be effective in preventing recurrence of urinary tract infections in women prone to such infections. Further studies are needed to determine optimal dosing of D-mannose for prophylaxis. In addition, more studies conducting an adequate comparison of D-mannose to conventional antimicrobial therapy are required before implementing this supplement as standard of care.