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The JAMA Network (open access)
....The continuing promotion of cranberry use to prevent
recurrent UTI in the popular press or online advice seems inconsistent
with the reality of repeated negative studies or positive studies
compromised by methodological shortcomings. Any continued promotion of
the use of cranberry products seems to go beyond available scientific
evidence and rational reasoning. Some of this conviction is likely an
interest of individuals or groups to promote the use of natural health
products for clinical benefits, allowing avoidance of medical
interventions and, potentially, giving women who experience recurrent
UTI an element of personal control in managing their problem. The
current emphasis on antimicrobial stewardship and limiting antimicrobial
use whenever possible also may have some influence in the continued
endorsement of cranberry juice or tablets as a nonantimicrobial strategy
for management of UTI.
What should be the current view of the role of cranberry
products for prevention of recurrent UTI in women? The evidence,
further supported by the study by Juthani-Mehta et al in an important
population, is convincing that cranberry products should not be
recommended as a medical intervention for the prevention of UTI. A
person may, of course, choose to use cranberry juice or capsules for
whatever reason she or he wishes. However, clinicians should not be
promoting cranberry use by suggesting that there is proven, or even
possible, benefit. Clinicians who encourage such use are doing their
patients a disservice. Recurrent UTI is a common problem that is
distressing to patients and because it is so frequent and costly for the
health care system. It is time to identify other potential approaches
for management. This certainly must include a wiser use of antimicrobial
therapy for syndromes of recurrent UTI in women in long-term care
facilities. Other possible interventions to explore in this and other
populations may include, among other approaches, adherence inhibitors or
immunologic interventions. Intellectual discussions and clinical trial
activity should be redirected to identify and evaluate other innovative
antimicrobial and nonantimicrobial approaches. It is time to move on
from cranberries.
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