Effects of a new combination of plant extracts plus d-mannose for the management of uncomplicated recurrent urinary tract infections

J Chemother. 2018 Apr;30(2):107-114. doi: 10.1080/1120009X.2017.1393587. Epub 2017 Oct 27.


Urinary tract infections (UTIs) are an economic burden for public health. The increasing prevalence of resistant bacteria which cause UTIs may be related to the inappropriate prescription of antibiotics. The aim of this preliminary study was to evaluate whether three different combinations of plant extracts plus d-mannose are effective in preventing the recurrence of UTIs. Three groups of patients received three combinations of plant extracts in conjunction with d-mannose. These were: berberine, arbutin and birch (group A); berberine, arbutin, birch and forskolin (group B); and proanthocyanidins (group C). The clinical recurrence of cystitis at the end of treatment and during follow-up was determined by comparison with baseline measurements using the microbiological assessment of urine samples, vaginal swabs and vaginal smear slides. Patients in groups A and B had a lower incidence of episodes of recurrent cystitis during treatment and follow-up, samples with a significantly lower median bacterial load and a reduction of the grade of lactobacillary flora compared to patients in group C.

Keywords: CFU, colony-forming units; CLSI, Clinical and Laboratory Standards Institute; Cystitis; GFR, glomerular filtration rate; LBG, lactobacillus grade; Plant extracts; Prevention; Recurrent urinary tract infections; UPEC, uropathogenic Escherichia coli; UTIs, urinary tract infections; cAMP, cyclic adenosine monophosphate; d-mannose.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anti-Bacterial Agents / pharmacology*
  • Cystitis / drug therapy*
  • Cystitis / microbiology
  • Drug Combinations
  • Escherichia coli / drug effects*
  • Escherichia coli Infections / drug therapy*
  • Escherichia coli Infections / microbiology
  • Female
  • Humans
  • Mannose / pharmacology*
  • Plant Extracts / pharmacology*
  • Recurrence
  • Urinary Tract Infections / drug therapy*
  • Urinary Tract Infections / microbiology


  • Anti-Bacterial Agents
  • Drug Combinations
  • Plant Extracts
  • Mannose