What is your approach to use of D-mannose for prevention of recurrent uncomplicated cystitis?

What is your approach to the use of D-mannose for the prevention of recurrent uncomplicated cystitis?

• I recommend D-mannose based on preclinical data and a small RCT
• I do not recommend D-mannose based on recent literature, prioritizing evidence-based options like vaginal estrogen therapy (for postmenopausal women), increased fluids, methenamine, and antibiotic prophylaxis
• I need more high-quality, placebo-controlled RCTs to be convinced of D-mannose’s efficacy before making a recommendation
• Other