Do you routinely recommend D-mannose or probiotics for patients with recurrent urinary tract infections?

I would like to add that estrogen is very helpful for postmenopausal women with recurrent UTIs-- and is underprescribed for this use. Data seems to be strongest for vaginal estrogen, but see for example, Tan-Kim et al., PMID 37178856 and Rosenblum, PMID 33927578.

My approach is to support patients who use these products if they think they are benefitting from them, but at the same time point out that the data in support of these modalities are weak. Nevertheless, if they think they are helping (obviously they are not infection free or they would not have bee...

I often recommend D mannose for patients with recurrent UTIs (especially if due to e coli). Some patients find the D mannose extremely helpful while others fine it useless. However, there is no real side effect or harm (and D mannose is not expensive overall). Therefore, I usually set expectations a...

The vast majority of instances of recurrent UTIs are due to mechanical changes in the lower urinary tract that commonly accompany advancing age, prior surgery, foreign bodies (e.g., stone), or adjacent malignancy. Temporary improvement can often be achieved with a carefully selected antibiotic, with...

I do not recommend D-mannose or oral probiotics, though in practice, when patients are already using these, I don't dissuade them, only advise them of the minimal evidence that they are beneficial (and significantly larger amount of evidence that they are not).

I would like to point out this trial of...

I don't discourage patients' use of probiotics, D-mannose, or cranberry pills, but I make them aware of the little available evidence that they are actually helpful. I do recommend the vaginal Estrace at least 3x week in postmenopausal women and methenamine if they can tolerate it, which has better ...