Wednesday, August 3, 2011

Cranberries vs Antibiotics to Prevent Urinary Tract Infections

Cranberry capsules or antibiotics?
The antimicrobial effects of cranberry juice, for the prevention of urinary tract infections (UTIs) in women is well known. But which is more effective for the prevention of UTIs, cranberry capsules or antibiotics?


Published in the Archives of Internal Medicine, a recent study sought to compare, in a prospective head to head trial, the effects of cranberry capsules vs antibiotics for the prevention of UTIs in women.  In a double-blind, double-dummy noninferiority trial, 221 premenopausal women with recurrent UTIs were randomized to 12-month prophylaxis use of trimethoprim-sulfamethoxazole (TMP-SMX), 480 mg once daily, or cranberry capsules, 500 mg twice daily. 


After 12 months, the mean number of patients with at least 1 symptomatic UTI was higher in the cranberry than in the TMP-SMX group (4.0 vs 1.8; P = .02), and the proportion of patients with at least 1 symptomatic UTI was higher in the cranberry than in the TMP-SMX group (78.2% vs 71.1%). Median time to the first symptomatic UTI was 4 months for the cranberry and 8 months for the TMP-SMX group. 


However, there is one caveat. Use of antibiotics lead to resistance.  Antibiotic resistance did not increase in the cranberry group. After 1 month, in the cranberry group, 23.7% of fecal and 28.1% of asymptomatic bacteriuria E coli isolates were TMP-SMX resistant, whereas in the TMP-SMX group, 86.3% of fecal and 90.5% of asymptomatic bacteriuria E coli isolates were TMP-SMX resistant.


So, antibiotics are superior to cranberry capsules,for preventing cystitis but at a cost. That cost is the development of antimicrobial resistance. 


It is a zero sum game, of sorts.