Background
Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). This is the third update of our review first published in 1998 and updated in 2004 and 2008.

Objectives
To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations.

Search methods
We searched the Cochrane Renal Group's Specialised Register (4 June 2013) through contact with the Trials' Search Co-ordinator using search terms relevant to this review.We contacted companies involved with the promotion and distribution of cranberry preparations and checked reference lists of review articles and relevant studies.

Date of search: July 2012

Selection criteria
All randomised controlled trials (RCTs) or quasi-RCTs of cranberry products for the prevention of UTIs.

Data collection and analysis
Two authors independently assessed and extracted data. Information was collected on methods, participants, interventions and outcomes (incidence of symptomatic UTIs, positive culture results, side effects, adherence to therapy). Risk ratios (RR) were calculated where appropriate, otherwise a narrative synthesis was undertaken. Quality was assessed using the Cochrane risk of bias assessment tool.

Main results
This updated review includes a total of 24 studies (six cross-over studies, 11 parallel group studies with two arms; five with three arms, and two studies with a factorial design) with a total of 4473 participants. Ten studies were included in the 2008 update, and 14 studies have been added to this update. Thirteen studies (2380 participants) evaluated cranberry juice/concentrate; nine studies (1032 participants) evaluated cranberry tablets or capsules; one study compared cranberry juice and tablets; and one study compared cranberry capsules and tablets. The comparison/control arms were placebo, no treatment, water, methenamine hippurate, antibiotics, or lactobacillus. Eleven studies were not included in the meta-analyses because either the design was a cross-over study and data were not reported separately for the first phase, or there was a lack of relevant data. Data included in the meta-analyses showed that, compared with placebo, water or not treatment, cranberry products did not significantly reduce the occurrence of symptomatic UTI overall (RR 0.86, 95% CI 0.71 to 1.04) or for any the subgroups: women with recurrent UTIs (RR 0.74, 95% CI 0.42 to 1.31); older people (RR 0.75, 95% CI 0.39 to 1.44); pregnant women (RR 1.04, 95% CI 0.97 to 1.17); children with recurrent UTI (RR 0.48, 95% CI 0.19 to 1.22); cancer patients (RR 1.15 95% CI 0.75 to 1.77); or people with neuropathic bladder or spinal injury (RR 0.95, 95% CI: 0.75 to 1.20). Overall heterogeneity was moderate (I² = 55%). The effectiveness of cranberry was not significantly different to antibiotics for women (RR 1.31, 95% CI 0.85, 2.02) and children (RR 0.69 95% CI 0.32 to 1.51). There was no significant difference between gastrointestinal adverse effects from cranberry product compared to those of placebo/no treatment (RR 0.83, 95% CI 0.31 to 2.27). Many studies reported low compliance and high withdrawal/dropout problems which they attributed to palatability/acceptability of the products, primarily the cranberry juice. Most studies of other cranberry products (tablets and capsules) did not report how much of the 'active' ingredient the product contained, and therefore the products may not have had enough potency to be effective.

Authors' conclusions
Prior to the current update it appeared there was some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period, particularly for women with recurrent UTIs. The addition of 14 further studies suggests that cranberry juice is less effective than previously indicated. Although some of small studies demonstrated a small benefit for women with recurrent UTIs, there were no statistically significant differences when the results of a much larger study were included. Cranberry products were not significantly different to antibiotics for preventing UTIs in three small studies. Given the large number of dropouts/withdrawals from studies (mainly attributed to the acceptability of consuming cranberry products particularly juice, over long periods), and the evidence that the benefit for preventing UTI is small, cranberry juice cannot currently be recommended for the prevention of UTIs. Other preparations (such as powders) need to be quantified using standardised methods to ensure the potency, and contain enough of the 'active' ingredient, before being evaluated in clinical studies or recommended for use.

/pdf/cranberries-for-preventing-urinary-tract-infections-1k75nh41v9.pdf

Cranberries for preventing urinary tract infections

A-type cranberry proanthocyanidins and uropathogenic bacterial anti-adhesion activity.

https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000000296

Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline.

BACKGROUND: The objective of this study was to validate an improved 4-dimethylaminocinnamaldehyde (DMAC) colorimetric method using a commercially available standard (procyanidin A2), for the standard method for quantification of proanthocyanidins (PACs) in cranberry powders, in order to establish dosage guidelines for the uropathogenic bacterial anti-adhesion effect of cranberry.

RESULTS: Commercially available cranberry samples were obtained (five from U.S. sources and six from European sources) for PAC quantification in five different analytical laboratories. Each laboratory extracted and analyzed the samples using the improved DMAC method. Within-laboratory variation (mean ± SD) was 4.1 ± 1.7% RSD (range, 2.3–6.1% RSD) and the between laboratory variability was 16.9 ± 8.5% RSD (range, 8–32% RSD). For comparative purposes, the cranberry samples were alternatively quantified using weights of extracted PACs (gravimetric). The correlation coefficient between the two methods was 0.989.

CONCLUSION: This improved DMAC method provides a simple, robust and relatively specific spectrophotometric assay for total PACs in cranberry samples using commercially available procyanidin A2 dimer as a standard. DMAC is most useful within a given type of food such as cranberries, but may not be appropriate for comparing concentrations across different food types, particularly in those cases where large differences exist among the relative amounts of each oligomer and polymer. Copyright © 2010 Society of Chemical Industry

Multi-laboratory validation of a standard method for quantifying proanthocyanidins in cranberry powders.

Emerging evidence is elucidating how non-nutrient phytochemicals underlie the health promotion afforded by fruits and vegetables. This review focuses on Vaccinium macrocarpon, the American cranberry, compiling a comprehensive list of its known phytochemical components, and detailing their prevalence in cranberry fruit and its products. Flavonoids, especially colored anthocyanins, abundant flavonols, and unique proanthocyanidins, have attracted major research attention. Other notable active components include phenolic acids, benzoates, hydroxycinnamic acids, terpenes and organic acids. Health effects of cranberries, cranberry products, and isolated cranberry components in humans and animals, as well as in vitro, are debated. Evidence for protection from several bacterial pathogens, cancer, cardiovascular disease, and inflammation is compelling, while neuroprotection and anti-viral activity also have begun to draw new consideration. Emerging bioavailability data is considered and potential molecular mechanisms are evaluated, linking phytochemicals to health effects through their biochemical properties and reactions. Finally, the effects of processing and storage on cranberry phytochemicals is discussed, with a focus on identifying research gaps and novel means to preserve their natural, health-promoting components.

Phytochemicals of cranberries and cranberry products: characterization, potential health effects, and processing stability.

Cranberry concentrate: UTI prophylaxis.

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Cranberry concentrate: UTI prophylaxis.