Efficacy of D-Mannose Monotherapy vs. Other Agents in Preventing Recurrent Urinary Tract Infections in Women: A Systematic Review and Meta-Analysis

Recurrent urinary tract infections (rUTIs) are common and often difficult to manage among women and are frequently treated with antibiotic prophylaxis. However, growing awareness of antibiotic resistance has encouraged interest in non-antibiotic alternatives such as D-mannose, a naturally occurring sugar believed to prevent rUTIs by inhibiting bacterial adhesion to the urothelial surface. This review aims to evaluate the efficacy and safety of D-mannose monotherapy in preventing rUTIs in adult women compared with antibiotics, placebo, or no treatment. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searches were performed using PubMed and EMBASE. Eligible studies were randomized controlled trials or cohort studies evaluating D-mannose monotherapy for rUTIs prevention in adult women. The primary outcome was UTI recurrence, and the secondary outcome was adverse effects. Five studies met the inclusion criteria (3 RCTs, 1 prospective cohort, and 1 retrospective cohort), including 1038 women. A meta-analysis of 3 eligible studies comparing D-mannose to placebo/control (n = 831) demonstrated a non-significant reduction in rUTIs in the D-mannose group (risk ratio = 0.37, 95% CI 0.11-1.30, P = .10) with high heterogeneity (I2 = 94%). The largest and highestquality study showed no significant difference between D-mannose and placebo. Across all included studies, D-mannose appears to be well tolerated, with only mild and infrequent side effects. Although D-mannose appears safe and well-tolerated, the current evidence does not support its routine use in the prevention of recurrent urinary tract infections. Further high-quality trials are necessary to clarify its effectiveness in clinical practice. Cite this article as: Hajjaj AA, Maatoq AA, Asadi AA. Efficacy of D-mannose monotherapy vs. other agents in preventing recurrent urinary tract infections in women: A systematic review and meta-analysis. Urol Res Pract. 2025;51(6):208-216.