D-mannose có khả năng giảm nhiễm trùng và tránh tái phát viêm tiết niệu (rUTI) với hiệu quả có thể tương đương như kháng sinh

Urinary tract infections (UTIs) are very frequent in women and can be caused by a range of pathogens. High recurrence rates and increasing antibiotic resistance of uropathogens make UTIs a severe public health problem. d-mannose is a monosaccharide that can inhibit bacterial adhesion to the urothelium after oral intake. Several clinical studies have shown the efficacy of d-mannose in the prevention of recurrent UTIs; these also provided limited evidence for the efficacy of d-mannose in acute therapy. A recent prospective, non-interventional study in female patients with acute cystitis reported good success rates for treatment with d-mannose. Here, we present data from a post hoc analysis of this study to compare the cure rate of d-mannose monotherapy with that of antibiotics. The results show that d-mannose is a promising alternative to antibiotics in the treatment of acute uncomplicated UTIs in women.

Figures

Figure 1 

Exogenous d-mannose in UTI: mode of action scheme. (A) Adherence of uropathogens depends on binding of the adhesin, e.g., FimH protein (located at the tips of the bacteria’s type 1 pili) to mannosylated proteins, such as uroplakin 1a, located on the epithelial cell surface. (B) Exogenously delivered d-mannose can prevent adhesion of E. coli by saturating the FimH binding sites. Thus, d-mannose competitively inhibits adhesion of bacteria to the urothelium and facilitates their clearance by urine flow. GlcNAc: N-acetylglucosamine.

Figure 2 

Median aligned ACSS of “typical domain” (aACSS-TD) over 7 days for patients receiving (A) d-mannose monotherapy or (B) d-mannose and other measures except antibiotics. Clinical symptoms assessed in the NIS were transferred to the “typical domain” of the ACSS. The pooled summary score of the treated cohort is shown for each day as a box plot. The red line indicates the median aACSS-TD.

Figure 3 

Cure rates of patients with AUC treated with nitrofurantoin, fosfomycin or d-mannose [42,44,45,46]. Vertical line indicates cure rate of 75%. Squares indicate range from 1st to 3rd quartile of estimated cure rates. Horizontal lines indicate 95% CIs. ¹ Random effect model. ² d-mannose monotherapy (for numbers, see Table 2). ³ d-mannose and other measures except antibiotics (for numbers, see Table 2).

Figure 4 

Time course of mean symptom scores in AUC over 1 week in patients receiving d-mannose compared to median symptom score in patients receiving antibiotics (for data, see Table 3).

Nguồn: https://pubmed.ncbi.nlm.nih.gov/35326777/

https://pubmed.ncbi.nlm.nih.gov/32497610/