Cranberries for women with recurrent urinary tract infection: a meta-analysis

Keywords: cranberry, prophylaxis, urinary tract infection, women
Abstract viewed: 3595 times
PDF downloaded: 1704 times
HTML downloaded: 232 times
EPUB downloaded: 250 times


BACKGROUND Cranberries are the most widely used nonantibiotic prophylaxis for recurrent urinary tract infection (rUTI) in women; however, their efficacy still remains uncertain. Hence, this meta-analysis was aimed to assess the effectiveness, safety, and adherence of cranberry as a prophylactic drug for treating rUTI.

METHODS Literature search was conducted using PubMed, EBSCO, Science Direct, Scopus, Cochrane, and Google Scholar. Studies were screened for duplication, inclusion and exclusion criteria, and then reviewed by two authors independently. This included all randomized controlled trials of cranberry derivatives versus placebo and antibiotic prophylaxis. Cochrane risk-of-bias assessment tools were used to evaluate the quality of the study. Quantitative analysis was performed using the Review Manager 5.0 software.

RESULTS Nine studies were included. Among 1,542 participants, cranberry consumption reduced incidence of rUTI in women compared with placebo (p = 0.02). The subgroup analysis revealed that only cranberry capsules were superior to placebo (relative risk [RR] = 0.67, 95% confidence interval [CI] = 0.45-0.98), but not for cranberry juice (RR = 0.85, 95% CI: 0.7-1.04). Antibiotics had better outcome than cranberry for rUTI (RR = 0.83, 95% CI = 0.70-0.98). Most of the participants experienced minor adverse events such as rash and gastrointestinal symptoms. There was also a good adherence rate, ranging from 90.3-99% monthly dose.

CONCLUSIONS Cranberry, especially cranberry capsule consumption, had a significant effect in reducing the incidence of rUTI compared with placebo, with good adherence rates, and minor adverse events. In contrast, although antibiotic use had a greater efficacy, it was associated with a higher risk of severe adverse events.


  1. Vasileiou I, Katsargyris A, Theocharis S, Giaginis C. Current clinical status on the preventive effects of cranberry consumption against urinary tract infections. Nutr Res. 2013;33(8):595-607.

  2. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infection: Epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269-84.

  3. Tandogdu Z, Wagenlehner FME. Global epidemiology of urinary tract infections. Curr Opin Infect Dis. 2016;29(1):73-9.

  4. Sugianli AK, Ginting F, Kusumawati RL, Pranggono EH, Pasaribu AP, Gronthoud F, et al. Antimicrobial resistance in uropathogens and appropriateness of empirical treatment: a population-based surveillance study in Indonesia. J Antimicrob Chemother. 2017;72(5):1469-77.

  5. Liska DJ, Kern HJ, Maki KC. Cranberries and urinary tract infections: how can the same evidence lead to conflicting advice? Adv Nutr. 2016;7(3):498-506.

  6. Aydin A, Ahmed K, Zaman I, Khan MS, Dasgupta P. Recurrent urinary tract infections in women. Int Urogynecol J. 2015;26(6):795-804.

  7. Jhang JF, Kuo HC. Recent advances in recurrent urinary tract infection from pathogenesis and biomarkers to prevention. Ci Ji Yi Xue Za Zhi. 2017;29(3):131-7.

  8. Renard J, Ballarini S, Mascarenhas T, Zahran M, Quimper E, Choucair J, et al. Recurrent lower urinary tract infections have a detrimental effect on patient quality of life: a prospective, observational study. Infect Dis Ther. 2015;4(1):125-35.

  9. Mitchell BG, Ferguson JK, Anderson M, Sear J, Barnett A. Length of stay and mortality associated with healthcare-associated urinary tract infections: a multi-state model. J Hosp Infect. 2016;93(1):92-9.

  10. Ciani O, Grassi D, Tarricone R. An economic perspective on urinary tract infection: the "costs of resignation. Clin Drug Investig. 2013;33(4):255-61.

  11. Micali S, Isgro G, Bianchi G, Miceli N, Calapai G, Navarra M. Cranberry and recurrent cystitis: More than marketing? Crit Rev Food Sci Nutr. 2014;54(8):1063-75.

  12. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321.

  13. Bosmans JE, Beerepoot MAJ, Prins JM, ter Riet G, Geerlings SE. Cost-effectiveness of cranberries vs antibiotics to prevent urinary tract infections in premenopausal women: a randomized clinical trial. PLoS One. 2014;9(4):e91939.

  14. Beerepoot MA, ter Riet G, Nys S, van der Wal WM, de Borgie CA, de Reijke TM, et al. Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women. Arch Intern Med. 2013;171(14):1270-8.

  15. Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clin Infect Dis. 2011;52(1):23-30.

  16. Maki KC, Kaspar KL, Khoo C, Derrig LH, Schild AL, Gupta K. Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection. Am J Clin Nutr. 2016;103(6):1434-42.

  17. Vostalova J, Vidlar A, Simanek V, Galandakova A, Kosina P, Vacek J, et al. Are high proanthocyanidins key to cranberry efficacy in the prevention of recurrent urinary tract infection? Phytother Res. 2015;29(10):1559-67.

  18. Stapleton AE, Dziura J, Hooton TM, Cox ME, Yarova-Yarovaya Y, Chen S, et al. Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a randomized controlled trial. Mayo Clin Proc. 2012;87(2):143-50.

  19. McMurdo ME, Argo I, Phillips G, Daly F, Davey P. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. J Antimicrob Chemother. 2009;63(2):389-95.

  20. Gupta A, Dwivedi M, Mahdi AA, Nagana Gowda GA, Khetrapal CL, Bhandari M. Inhibition of adherence of multi-drug resistant E. coli by proanthocyanidin. Urol Res. 2012;40(2):143-50.

  21. Takahashi S, Hamasuna R, Yasuda M, Arakawa S, Tanaka K, Ishikawa K, et al. A randomized clinical trial to evaluate the preventive effect of cranberry juice (UR65) for patients with recurrent urinary tract infection. J Infect Chemother. 2013;19(1):112-7.

  22. Juthani-Mehta M, Van Ness PH, Bianco L, Rink A, Rubeck S, Ginter S, et al. Effect of cranberry capsules on bacteriuria plus pyuria among older women in nursing homes: a randomized clinical trial. JAMA. 2016;316(18):1879-87.

  23. Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ. 2001;322(7302):1571.

  24. Guay DR. Cranberry and urinary tract infections. Drugs. 2009;69(7):775-807.

  25. Hisano M, Bruschini H, Nicodemo AC, Srougi M. Cranberries and lower urinary tract infection prevention. Clinics. 2012;67(6):661-7.

How to Cite
Tambunan MP, Rahardjo HE. Cranberries for women with recurrent urinary tract infection: a meta-analysis. Med J Indones [Internet]. 2019Oct.4 [cited 2022Dec.9];28(3):268-75. Available from:
Clinical Research