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| 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.
