795. Cranberries Versus Trimethoprim/Sulfamethoxazole to Prevent Urinary Tract Infections in Premenopausal Women: a Double-Blind Non-Inferiority Trial
Session: Abstracts: Oral Abstract Session: Bacterial Clinical Studies I
Friday, October 22, 2010: 2:15 PM

The increasing prevalence of uropathogens resistant to antimicrobial agents has stimulated interest in cranberries for the prevention of recurrent urinary tract infections (rUTIs). Cranberries inhibit the adherence of Escherichia coli to uroepithelial cells.


In a double dummy double-blind non-inferiority trial 221 premenopausal women with rUTIs (mean numbers of UTIs 6.5 and 7.8/year) were randomized to 12-months prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMX) 480 mg QD or cranberry capsules 500 mg BID. Primary endpoints were the cumulative number of symptomatic UTIs at 12 months, analyzed using inverse probability weighting to correct for selective dropout,  median times to first UTI and development of antibiotic resistance in Escherichia coli


After 1 year the mean number of symptomatic UTIs was significantly higher in the cranberry than in the TMP/SMX group (4.0 and 1.8, respectively; p=0.01). Median times to first symptomatic UTI were 4 and 8 months for the cranberry and TMP/SMX group respectively. In the cranberry group, after 1 month, 24% and 28% of faecal and asymptomatic bacteriuria E. coli isolates were TMP/SMX resistant, compared to 86% and 91% in the TMP/SMX group. After 1 month on TMP/SMX an increase was also seen in resistance of faecal and asymptomatic bacteriuria E. coli isolates to trimethoprim (88 and 91%), amoxicillin (73 and 86%), and ciprofloxacin (16 and 19%). After discontinuation of TMP/SMX, resistance gradually decreased during the washout period of 3 months.


In premenopausal women, TMP/SMX is more effective than cranberry capsules for the prevention of rUTIs, at the expense of the emergence of antibiotic resistance.  

Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Marielle A. Beerepoot, MD , AMC, Amsterdam, Netherlands
Gerben Ter Riet, MD, PhD , AMC, Amsterdam, Netherlands
Sita Nys, PhD , Maastricht Medical Center, Maastricht, Netherlands
Willem M. Van Der Wal, PhD , AMC, Amsterdam, Netherlands
Corianne A. De Borgie, MD, PhD , AMC, Amsterdam, Netherlands
Theo M. De Reijke, MD, PhD , AMC, Amsterdam, Netherlands
Jan M. Prins, Professor, MD , AMC, Amsterdam, Netherlands
Jeanne Koeijers, MD , Maastricht Medical Center, Maastricht, Netherlands
Annelies Verbon, MD, PhD , Erasmus Medical Center, Rotterdam, Netherlands
Ellen E. Stobberingh, PhD , Maastricht Medical Center, Maastricht, Netherlands
Suzanne E. Geerlings, MD, PhD , AMC, Amsterdam, Netherlands


M. A. Beerepoot, Yes
Springfield Nutraceuticals BV: Payment of cranberry capsules and placebo capsules,

G. Ter Riet, None

S. Nys, None

W. M. Van Der Wal, None

C. A. De Borgie, None

T. M. De Reijke, None

J. M. Prins, None

J. Koeijers, None

A. Verbon, None

E. E. Stobberingh, None

S. E. Geerlings, Yes
Springfield Nutraceuticals BV: Disposal of cranberry capsules and placebo capsules, Cranberry capsules and placebo capsules

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 21 with the exception of research findings presented at IDSA press conferences.


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