Effect of oral cranberry extract (standardized proanthocyanidin-A) in patients with recurrent UTI by pathogenic E. coli: a randomized placebo-controlled clinical research study.
OBJECTIVE
To evaluate the effect of cranberry extract (PAC-A ~ proanthocyanidin-A) on the in vitro bacterial properties of uropathogenic (E. coli) and its efficacy/tolerability in patients with subclinical or uncomplicated recurrent UTI (r-UTI).


METHODS
After obtaining clearance from the ethics committee and administering a written informed consent, 72 patients with r-UTI were enrolled as per protocol (November 2011 to March 2013) in this prospective study, to randomly receive (PAC-A: group I, 36) or (placebo: group II, 36), for 12 weeks. Any change/reduction in the incidence of r-UTI at 12 weeks was construed to be the primary endpoint of this study.


RESULTS
After 12 weeks, bacterial adhesion scoring decreased (0.28)/(2.14) in group I/II (p < 0.001); 32/36 (88.8 %) and 2/36 (5.5 %) in groups I and II, respectively, turned MRHA negative (p < 0.001); biofilm (p < 0.01) and bacterial growth (p < 0.001) decreased in group I; microscopic pyuria score was 0.36/2.0 in group I/II (p < 0.001); r-UTI decreased to 33.33 versus 88.89 % in group I/II (p < 0.001); mean subjective dysuria score was 0.19 versus 1.47 in group I/II (p < 0.001), while mean urine pH was 5.88 versus 6.30 in group I/II (p < 0.001). No in vitro antibacterial activity of cranberry could be demonstrated, and no adverse events were noted.


CONCLUSIONS
The overall efficacy and tolerability of standardized cranberry extract containing (PAC-A) as a food supplement were superior to placebo in terms of reduced bacterial adhesion; bacterial MRHA negativity; urine pH reduction; and in preventing r-UTI (dysuria, bacteriuria and pyuria). Larger randomized controlled trials are needed to elucidate the precise role, exact dose and optimal duration of PAC-A therapy in patients at risk of r-UTI.
Departments of Surgery (Urology), University College of Medical Sciences (University of Delhi) & GTB Hospital, Shahdara, Dilshad Garden, New Delhi, 110095, Delhi, India. iqbalsinghp@yahoo.co.uk.
Iqbal
I
Singh
Departments of Surgery (Urology), University College of Medical Sciences (University of Delhi) & GTB Hospital, Shahdara, Dilshad Garden, New Delhi, 110095, Delhi, India.
Lokesh Kumar
LK
Gautam
Departments of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, New Delhi, 95, India.
Iqbal R
IR
Kaur
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D001422:Bacterial Adhesion / Q000187:drug effects; D018441:Biofilms / Q000187:drug effects; D019587:Dietary Supplements; D053159:Dysuria / Q000382:microbiology; D004926:Escherichia coli / Q000187:drug effects; D004927:Escherichia coli Infections / Q000150:complications / Q000517:prevention & control*; D006386:Hemagglutination Tests; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D008517:Phytotherapy; D010936:Plant Extracts / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D011776:Pyuria / Q000382:microbiology; D012008:Recurrence; D055502:Secondary Prevention; D014552:Urinary Tract Infections / Q000382:microbiology / Q000517:prevention & control*; D014556:Urine / Q000737:chemistry; D029799:Vaccinium macrocarpon / Q000737:chemistry*; D055815:Young Adult
C000621229:Cranpac; D010936:Plant Extracts
Cranberry; Escherichia coli; Lactobacillus; Non-antibiotic strategies; Proanthocyanidin-A; Urinary tract infection; Vaccinium macrocarpon