Cranberry and Urinary Tract Infections

Abstract

Urinary tract infection (UTI) refers to the presence of clinical signs and symptoms arising from the genitourinary tract plus the presence of one or more micro-organisms in the urine exceeding a threshold value for significance (ranges from 102 to 103 colony-forming units/mL). Infections are localized to the bladder (cystitis), renal parenchyma (pyelonephritis) or prostate (acute or chronic bacterial prostatitis). Single UTI episodes are very common, especially in adult women where there is a 50-fold predominance compared with adult men. In addition, recurrent UTIs are also common, occurring in up to one-third of women after first-episode UTIs. Recurrences requiring intervention are usually defined as two or more episodes over 6 months or three or more episodes over 1 year (this definition applies only to young women with acute uncomplicated UTIs).

A cornerstone of prevention of UTI recurrence has been the use of low-dose once-daily or post-coital antimicrobials; however, much interest has surrounded non-antimicrobial-based approaches undergoing investigation such as use of probiotics, vaccines, oligosaccharide inhibitors of bacterial adherence and colonization, and bacterial interference with immunoreactive extracts of Escherichia coli. Local (intravaginal) estrogen therapy has had mixed results to date.

Cranberry products in a variety of formulations have also undergone extensive evaluation over several decades in the management of UTIs. At present, there is no evidence that cranberry can be used to treat UTIs. Hence, the focus has been on its use as a preventative strategy. Cranberry has been effective in vitro and in vivo in animals for the prevention of UTI. Cranberry appears to work by inhibiting the adhesion of type I and P-fimbriated uro-pathogens (e.g. uropathogenic E. coli) to the uroepithelium, thus impairing colonization and subsequent infection. The isolation of the component(s) of cranberry with this activity has been a daunting task, considering the hundreds of compounds found in the fruit and its juice derivatives. Reasonable evidence suggests that the anthocyanidin/proanthocyanidin moieties are potent antiadhesion compounds. However, problems still exist with standardization of cranberry products, which makes it extremely difficult to compare products or extrapolate results. Unfortunately, most clinical trials have had design deficiencies and none have evaluated specific key cranberry-derived compounds considered likely to be active moieties (e.g. proantho-cyanidins). In general, the preventive efficacy of cranberry has been variable and modest at best. Meta-analyses have established that recurrence rates over 1 year are reduced approximately 35% in young to middle-aged women. The efficacy of cranberry in other groups (i.e. elderly, paediatric patients, those with neurogenic bladder, those with chronic indwelling urinary catheters) is questionable. Withdrawal rates have been quite high (up to 55%), suggesting that these products may not be acceptable over long periods. Adverse events include gastrointestinal intolerance, weight gain (due to the excessive calorie load) and drug-cranberry interactions (due to the inhibitory effect of flavo-noids on cytochrome P450-mediated drug metabolism). The findings of the Cochrane Collaboration support the potential use of cranberry products in the prophylaxis of recurrent UTIs in young and middle-aged women. However, in light of the heterogeneity of clinical study designs and the lack of consensus regarding the dosage regimen and formulation to use, cranberry products cannot be recommended for the prophylaxis of recurrent UTIs at this time.

This is a preview of subscription content, log in to check access.

Table I
Table II
Table III
Table IV
Table V

References

  1. 1.

    Guay DRP. Contemporary management of uncomplicated urinary tract infections. Drugs 2008; 68: 1169–205

    PubMed  CAS  Article  Google Scholar 

  2. 2.

    Stapleton A. Novel approaches to prevention of urinary tract infections. Infect Dis Clin North Am 2003; 17: 457–71

    PubMed  Article  Google Scholar 

  3. 3.

    Miller JL, Krieger JN. Urinary tract infections: cranberry juice, underwear, and probiotics in the 21st century. Urol Clin North Am 2002; 29: 695–9

    PubMed  Article  Google Scholar 

  4. 4.

    Ruel G, Couillard C. Evidence of the cardioprotective potential of fruits: the case of cranberries. Mol Nutr Food Res 2007; 51: 692–701

    PubMed  CAS  Article  Google Scholar 

  5. 5.

    Neto CC. Cranberry and blueberry: evidence for protective effects against cancer and vascular diseases. Mol Nutr Food Res 2007; 51: 652–64

    PubMed  CAS  Article  Google Scholar 

  6. 6.

    Weiss EI, Lev-Dor R, Sharon N, et al. Inhibitory effect of a high-molecular-weight constituent of cranberry on adhesion of oral bacteria. Crit Rev Food Sci Nutr 2002; 42 (Suppl.): 285–92

    PubMed  CAS  Article  Google Scholar 

  7. 7.

    Steinberg D, Feldman M, Ofek I, et al. Cranberry high molecular weight constituents promote Streptococcus sobrinus desorption from artificial biofilm. Int J Anti-microb Agents 2005; 25: 247–51

    CAS  Article  Google Scholar 

  8. 8.

    Duarte S, Gregoire S, Singh AP, et al. Inhibitory effects of cranberry polyphenols on formation and acidogenicity of Streptococcus mutans biofilms. FEMS Microbiol Lett 2006; 257: 50–56

    PubMed  CAS  Article  Google Scholar 

  9. 9.

    Weiss EI, Kozlovsky A, Steinberg D, et al. A high molecular mass cranberry constituent reduces mutans streptococci level in saliva and inhibits in vitro adhesion to hydroxyapatite. FEMS Microbiol Lett 2004; 232: 89–92

    PubMed  CAS  Article  Google Scholar 

  10. 10.

    Vattem DA, Ghaedian R, Shetty K. Enhancing health benefits of berries through phenolic antioxidant enrichment: focus on cranberry. Asia Pac J Clin Nutr 2005; 14: 120–30

    PubMed  CAS  Google Scholar 

  11. 11.

    Yamanaka A, Kouchi T, Kasai K, et al. Inhibitory effect of cranberry polyphenol on biofilm formation and cysteine proteases of Porphyromonas gingivalis. J Periodont Res 2007; 42: 589–92

    PubMed  CAS  Article  Google Scholar 

  12. 12.

    Labrecque J, Bodet C, Chandad F, et al. Effects of a high-molecular-weight cranberry fraction on growth, biofilm formation and adherence of Porphyromonas gingivalis. J Antimicrob Chemother 2006; 58: 439–43

    PubMed  CAS  Article  Google Scholar 

  13. 13.

    Bodet C, Piche M, Chandad F, et al. Inhibition of period-ontopathogen-derived proteolytic enzymes by a high-molecular-weight fraction isolated from cranberry. J Antimicrob Chemother 2006; 57: 685–90

    PubMed  CAS  Article  Google Scholar 

  14. 14.

    Lipson SM, Sethi L, Cohen P, et al. Antiviral effects on bacteriophages and rotavirus by cranberry juice. Phytomedicine 2007; 14: 23–30

    PubMed  CAS  Article  Google Scholar 

  15. 15.

    Weiss EI, Houri-Haddad Y, Greenbaum E, et al. Cranberry juice constituents affect influenza virus adhesion and infectivity. Antiviral Res 2005; 66: 9–12

    PubMed  CAS  Article  Google Scholar 

  16. 16.

    Lipson SM, Cohen P, Zhou J, et al. Cranberry cocktail juice, cranberry concentrates, and proanthocyanidins reduce reovirus infectivity titers in African green monkey kidney epithelial cell cultures. Mol Nutr Food Res 2007; 51: 752–8

    PubMed  CAS  Article  Google Scholar 

  17. 17.

    Ofek I, Goldhar J, Sharon N. Anti-Escherichia coli adhesion activity of cranberry and blueberry juices. Adv Exp Med Biol 1996; 408: 179–83

    PubMed  CAS  Article  Google Scholar 

  18. 18.

    Fanos V, Atzei A, Zaffanello M, et al. Cranberry and prevention of urinary tract infections in children. J Chemother 2006; 18 Spec no. 3: 21–4

    Google Scholar 

  19. 19.

    Raz R, Chazan B, Dan M. Cranberry juice and urinary tract infection. Clin Infect Dis 2004; 38: 1413–9

    PubMed  CAS  Article  Google Scholar 

  20. 20.

    Turner A, Chen S-N, Joike MK, et al. Inhibition of uro-pathogenic Escherichia coli by cranberry juice: a new antiadherence assay. J Agric Food Chem 2005; 53: 8940–7

    PubMed  CAS  Article  Google Scholar 

  21. 21.

    Jensen HD, Krogfelt KA, Cornett C, et al. Hydrophilic carboxylic acids and iridoid glycosides in the juice of American and European cranberries (Vaccinium macro-carpon and V. oxycoccus), lingonberries (V. vitis-idaea), and blueberries (V. myrtillus). J Agric Food Chem 2002; 50: 6871–974

    PubMed  CAS  Article  Google Scholar 

  22. 22.

    Zhang K, Zuo Y. GC-MS determination of flavonoids and phenolic and benzoic acids in human plasma after consumption of cranberry juices. J Agric Food Chem 2004; 52: 222–7

    PubMed  CAS  Article  Google Scholar 

  23. 23.

    Duthie GB, Kyle JAM, Jenkinson AMcE, et al. Increased salicylate concentrations in urine of human volunteers after consumption of cranberry juice. J Agric Food Chem 2005; 53: 2897–900

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Vvedenskaya IO, Rosen RT, Guido JE, et al. Characterization of flavonols in cranberry (Vaccinium macrocarpon) powder. J Agric Food Chem 2004; 52: 188–95

    PubMed  CAS  Article  Google Scholar 

  25. 25.

    Hakkinen SH, Karenlampi SO, Heinonen IM, et al. Content of the flavonols quercetin, myricetin, and kaempferol in 25 edible berries. J Agric Food Chem 1999; 47: 2274–9

    PubMed  CAS  Article  Google Scholar 

  26. 26.

    Ohnishi R, Ito H, Kasajima N, et al. Urinary excretion of anthocyanins in humans after cranberry juice ingestion. Biosci Biotechnol Biochem 2006; 70: 1681–7

    PubMed  CAS  Article  Google Scholar 

  27. 27.

    Foo LY, Lu Y, Howell AB, et al. The structure of cranberry proanthocyanidins which inhibit adherence of uropathogenic P-fimbriated Escherichia coli in vitro. Phytochemistry 2000; 54: 173–81

    PubMed  CAS  Article  Google Scholar 

  28. 28.

    Howell AB, Reed JD, Krueger CG, et al. A-type cranberry proanthocyanidins and uropathogenic bacterial anti-adhesion activity. Phytochemistry 2005; 66: 2281–91

    PubMed  CAS  Article  Google Scholar 

  29. 29.

    Gupta K, Chou MY, Howell A, et al. Cranberry products inhibit adherence of p-fimbriated Escherichia coli to primary cultured bladder and vaginal epithelial cells. J Urol 2007; 177: 2357–60

    PubMed  CAS  Article  Google Scholar 

  30. 30.

    Sobota AE. Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infections. J Urol 1984; 131: 1013–6

    PubMed  CAS  Google Scholar 

  31. 31.

    Ahuja S, Kaack B, Roberts J. Loss of fimbrial adhesion with the addition of Vaccinium macrocarpon to the growth medium of P-fimbriated Escherichia coli. J Urol 1998; 159: 559–62

    PubMed  CAS  Article  Google Scholar 

  32. 32.

    Valentova K, Stejskal D, Bednar P, et al. Biosafety, anti-oxidant status, and metabolites in urine after consumption of dried cranberry juice in healthy women: a pilot double-blind placebo-controlled trial. J Agric Food Chem 2007; 55: 3217–24

    PubMed  CAS  Article  Google Scholar 

  33. 33.

    Lee Y-L, Owens J, Thrupp L, et al. Does cranberry juice have any antibacterial activity? [letter]. JAMA 2000; 283: 1691

    PubMed  CAS  Article  Google Scholar 

  34. 34.

    Allison DG, Cronin MA, Hawker J, et al. Influence of cranberry juice on attachment of Escherichia coli to glass. J Basic Microbiol 2000; 40: 3–6

    PubMed  CAS  Article  Google Scholar 

  35. 35.

    Cavanagh HMA, Hipwell M, Wilkinson JM. Antibacterial activity of berry fruits used for culinary purposes. J Med Food 2003; 6: 57–61

    PubMed  CAS  Article  Google Scholar 

  36. 36.

    Leitao DPS, Polizello ACM, Ito IY, et al. Antibacterial screening of anthocyanic and proanthocyanic fractions from cranberry juice. J Med Food 2005; 8: 36–40

    PubMed  CAS  Article  Google Scholar 

  37. 37.

    Zafriri D, Ofek I, Adar R, et al. Inhibitory activity of cranberry juice on adherence of type 1 and type P fim-briated Escherichia coli to eukaryotic cells. Antimicrob Agents Chemother 1989; 33: 92–8

    PubMed  CAS  Article  Google Scholar 

  38. 38.

    Schmidt DR, Sobota AE. An examination of the anti-adherence activity of cranberry juice on urinary and nonurinary bacterial isolates. Microbios 1988; 55: 173–81

    PubMed  CAS  Google Scholar 

  39. 39.

    Johnson-White B, Buquo L, Zeinali M, et al. Prevention of nonspecific bacterial cell adhesion in immunoassays by use of cranberry juice. Anal Chem 2006; 78: 853–7

    PubMed  CAS  Article  Google Scholar 

  40. 40.

    Eydelnant IA, Tufenkji N. Cranberry derived proanthocyanidins reduce bacterial adhesion to selected biomate-rials. Langmuir 2008; 24: 10273–81

    PubMed  CAS  Article  Google Scholar 

  41. 41.

    Koo H, Nino de Guzman P, Schobel BD, et al. Influence of cranberry juice on glucan-mediated processes involved in Streptococcus mutans biofilm development. Caries Res 2006; 40: 20–7

    PubMed  CAS  Article  Google Scholar 

  42. 42.

    Dearing MD, Appel HM, Schultz JC. Why do cranberries reduce incidence of urinary tract infections? [letter]. J Ethnopharmacol 2002; 80: 211

    PubMed  Article  Google Scholar 

  43. 43.

    Howell AB, Foxman B. Cranberry juice and adhesion of antibiotic-resistant uropathogens [letter]. JAMA 2002; 287: 3082–3

    PubMed  Article  Google Scholar 

  44. 44.

    Foo LY, Lu Y, Howell AB, et al. A-type proanthocyanidin trimers from cranberry that inhibit adherence of uropathogenic Escherichia coli. J Natl Prod 2000; 63: 1225–8

    CAS  Article  Google Scholar 

  45. 45.

    Di Martino P, Agniel R, Gaillard JL, et al. Effects of cranberry juice on uropathogenic Escherichia coli in vitro biofilm formation. J Chemother 2005; 17: 563–5

    PubMed  Google Scholar 

  46. 46.

    Reid G, Hsiehl J, Potter P, et al. Cranberry juice consumption may reduce biofilms on uroepithelial cells: pilot study in spinal cord injured patients. Spinal Cord 2001; 39: 26–30

    PubMed  CAS  Article  Google Scholar 

  47. 47.

    Morris NS, Strickler DJ. Does drinking cranberry juice produce urine inhibitory to the development of crystalline, catheter-blocking Proteus mirabilis biofilms? BJU Int 2001; 88: 192–7

    PubMed  CAS  Article  Google Scholar 

  48. 48.

    Kinney AB, Blount M. Effect of cranberry juice on urine pH. Nurs Res 1979; 28: 287–90

    PubMed  CAS  Article  Google Scholar 

  49. 49.

    Bodel PT, Cotran R, Kass EH. Cranberry juice and the antibacterial action of hippuric acid. J Lab Clin Med 1959; 54: 881–8

    PubMed  CAS  Google Scholar 

  50. 50.

    Fellers CR, Redmon BC, Parrott EM. Effect of cranberries on urinary acidity and blood alkali reserve. J Nutrition 1933; 6: 455–63

    CAS  Google Scholar 

  51. 51.

    Blatherwick NR, Long ML. Studies of urinary acidity. II: the increased acidity produced by eating prunes and cranberries. J Biol Chem 1923; 57: 815–8

    CAS  Google Scholar 

  52. 52.

    Kahn HD, Panariello VA, Saeli J, et al. Effect of cranberry juice on urine. J Am Diet Assoc 1967; 51: 251–4

    PubMed  CAS  Google Scholar 

  53. 53.

    Nahata HC, Cummins BA, McLeod DC, et al. Predictability of methenamine efficacy based on type of urinary pathogen and pH. J Am Geriatr Soc 1981; 29: 236–9

    PubMed  CAS  Google Scholar 

  54. 54.

    Jackson B, Hicks LE. Effect of cranberry juice on urinary pH in older adults. Home Health Nurse 1997; 15: 198–202

    CAS  Google Scholar 

  55. 55.

    Blatherwick NR. The specific role of foods in relation to the composition of the urine. Arch Intern Med 1914; 14: 409–50

    CAS  Article  Google Scholar 

  56. 56.

    Habash MB, van der Mei HC, Busscher HJ, et al. The effect of water, ascorbic acid, and cranberry derived supplementation on human urine and uropathogen adhesion to silicone rubber. Can J Microbiol 1999; 45: 691–4

    PubMed  CAS  Article  Google Scholar 

  57. 57.

    Lavigne J-P, Bourg G, Combescure C, et al. In-vitro and in-vivo evidence of dose-dependent decrease of uropathogenic Escherichia coli virulence after consumption of commercial Vaccinium macrocarpon (cranberry) capsules. Clin Microbiol Infect 2008; 14: 350–5

    PubMed  Article  Google Scholar 

  58. 58.

    Han CH, Kim SH, Kang SH, et al. Protective effects of cranberries on infection-induced oxidative renal damage in a rabbit model of vesico-ureteric reflux. BJU Int 2007; 100: 1172–5

    PubMed  Google Scholar 

  59. 59.

    Tong H, Heong S, Chang S. Effect of ingesting cranberry juice on bacterial growth in urine. Am J Health-Syst Pharm 2006; 63: 1417–9

    PubMed  Article  Google Scholar 

  60. 60.

    Greenberg JA, Newmann SJ, Howell AB. Consumption of sweetened dried cranberries versus unsweetened raisins for inhibition of uropathogenic Escherichia coli adhesion in human urine: a pilot study. J Altern Compl Med 2005; 11: 875–8

    Article  Google Scholar 

  61. 61.

    Di Martino P, Agniel R, David K, et al. Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial. World J Urol 2006; 24: 21–7

    PubMed  Article  Google Scholar 

  62. 62.

    Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein bound vitamin B12 absorption. J Am Coll Nutrition 1994; 13: 584–91

    CAS  Google Scholar 

  63. 63.

    Rhee KY, Charles M. Antimicrobial mechanisms of cranberry juice [letter]. Clin Infect Dis 2004; 39: 877

    PubMed  Article  Google Scholar 

  64. 64.

    Ofek I, Mirelman D, Sharon N. Adherence of Escherichia coli to human mucosal cells mediated by mannose receptors. Nature 1977; 265: 623–5

    PubMed  CAS  Article  Google Scholar 

  65. 65.

    Aronson M, Medalia O, Schori L, et al. Prevention of colonization of the urinary tract of mice with Escherichia coli by blocking of bacterial adherence with methyl α-D-mannopyranoside. J Infect Dis 1979; 139: 329–32

    PubMed  CAS  Article  Google Scholar 

  66. 66.

    Liu Y, Black MA, Caron L, et al. Role of cranberry juice on molecular-scale surface characteristics and adhesion behavior of Escherichia coli. Biotechnol Bioengineer 2006; 93: 297–305

    CAS  Article  Google Scholar 

  67. 67.

    Liu Y, Gallardo-Moreno AM, Pinzon-Arango PA, et al. Cranberry changes the physicochemical surface properties of E. coli and adhesion with uroepithelial cells. Coll Surf B: Biointerfaces 2008; 65: 35–42

    CAS  Article  Google Scholar 

  68. 68.

    Gibson L, Pike L, Kilbourn JP. Effectiveness of cranberry juice in preventing urinary tract infections in long-term care facility patients. J Naturopath Med 1991; 2: 45–7

    Google Scholar 

  69. 69.

    Moen DV. Observations on the effectiveness of cranberry juice in urinary infections. Wisc Med J 1962; 61: 282–3

    CAS  Google Scholar 

  70. 70.

    Nowack R, Schmitt W. Cranberry juice for prophylaxis of urinary tract infections-conclusions from clinical experience and research. Phytomedicine 2008; 15: 653–67

    CAS  Article  Google Scholar 

  71. 71.

    Walker EB, Barney DP, Mickelson JN, et al. Cranberry concentrate: UTI prophylaxis [letter]. J Fam Prac 1997; 45: 167–8

    CAS  Google Scholar 

  72. 72.

    Kontiokari T, Sundqvist K, Nuutinen M, et al. Randomized trial of cranberry-lingonberry juice and lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 2001; 322: 1571–3

    PubMed  CAS  Article  Google Scholar 

  73. 73.

    Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol 2002; 9: 1558–62

    PubMed  Google Scholar 

  74. 74.

    Bailey DT, Dalton C, Daugherty FJ, et al. Can a concentrated cranberry extract prevent recurrent urinary tract infections in women? A pilot study. Phytomedicine 2007; 14: 237–41

    PubMed  CAS  Article  Google Scholar 

  75. 75.

    McGuinness SD, Krone R, Metz LM. A double-blind, randomized, placebo-controlled trial of cranberry supplements in multiple sclerosis. J Neurosci Nurs 2002; 34: 4–7

    Article  Google Scholar 

  76. 76.

    Waites KB, Canupp KC, Armstrong S, et al. Effect of cranberry extract on bacteriuria and pyuria in persons with neurogenic bladder secondary to spinal cord injury. J Spinal Cord Med 2004; 27: 35–40

    PubMed  Google Scholar 

  77. 77.

    Linsenmeyer TA, Harrison B, Oakley A, et al. Evaluation of cranberry supplement for reduction of urinary tract infections in individuals with neurogenic bladders secondary to spinal cord injury. a prospective, double-blinded, placebo-controlled, crossover study. J Spinal Cord Med 2004; 27: 29–34

    Google Scholar 

  78. 78.

    Lee BB, Haran MJ, Hunt LM, et al. Spinal-injured neuropathic bladder antisepsis (SINBA) trial. Spinal Cord 2007; 45: 542–50

    PubMed  CAS  Article  Google Scholar 

  79. 79.

    Hess MJ, Hess PE, Sullivan MR, et al. Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder. Spinal Cord 2008; 46: 622–6

    PubMed  CAS  Article  Google Scholar 

  80. 80.

    Avorn J, Monane M, Gurwitz JA, et al. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA 1994; 271: 751–4

    PubMed  CAS  Article  Google Scholar 

  81. 81.

    McMurdo MET, Bissett LY, Price RJG, et al. Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in hospital? A double-blind, placebo-controlled trial. Age Ageing 2005; 34: 256–61

    PubMed  Article  Google Scholar 

  82. 82.

    Wing DA, Rumney PJ, Preslicka CW, et al. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol 2008; 180: 1367–72

    PubMed  Article  Google Scholar 

  83. 83.

    Foda MMR, Middlebrook PF, Gatfield CT, et al. Efficacy of cranberry in prevention of urinary tract infection in a susceptible pediatric population. Can J Urol 1995; 2: 98–102

    PubMed  Google Scholar 

  84. 84.

    Schlager TA, Anderson S, Trudell J, et al. Effect of cranberry juice on bacteriuria in children with neurogenic bladder receiving intermittent catheterization. J Pediatr 1999; 135: 698–702

    PubMed  CAS  Article  Google Scholar 

  85. 85.

    Avorn J, Monane M, Gurwitz J, et al. Reduction of bacteriuria and pyuria with cranberry beverage: a randomized trial [abstract no. A51]. J Am Geriatr Soc 1993; 41 (Suppl.): SA13

    Google Scholar 

  86. 86.

    Jepson RG, Craig J. A systematic review of the evidence for cranberries and blueberries in UTI prevention. Mol Nutr Food Res 2007; 51: 738–45

    PubMed  CAS  Article  Google Scholar 

  87. 87.

    Jepson RG, Craig J. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2008; (1): CD001321

  88. 88.

    Kontiokari T, Salo J, Eerola E, et al. Cranberry juice and bacterial colonization in children: a placebo-controlled randomized trial. Clin Nutr 2005; 24: 1065–72

    PubMed  CAS  Article  Google Scholar 

  89. 89.

    Elliott SP, Villar R, Duncan B. Bacteriuria management and urological evaluation of patients with spina bifida and neurogenic bladder: a multicenter survey. J Urol 2005; 173: 217–20

    PubMed  Article  Google Scholar 

  90. 90.

    Super EA, Kemper KJ, Woods C, et al. Cranberry use among pediatric nephrology patients. Ambul Pediatr 2005; 5: 249–52

    PubMed  Article  Google Scholar 

  91. 91.

    Hutchinson J. Do cranberries help prevent urinary tract infections? Nurs Times 2005; 101: 38–40

    PubMed  Google Scholar 

  92. 92.

    Jepson RG, Mihaljevic L, Craig J. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev2004;(2):CD001321

  93. 93.

    Crews Jr WD, Harrison DW, Griffin ML, et al. A double-blind, placebo-controlled, randomized trial of the neu-ropsychologic efficacy of cranberry juice in a sample of cognitively intact older adults: pilot study finding. J Altern Compl Med 2005; 11: 305–9

    Article  Google Scholar 

  94. 94.

    Davies JK, Ahktar N, Ranasinge E. A juicy problem. Lancet 2001; 358: 2126

    PubMed  CAS  Article  Google Scholar 

  95. 95.

    Kessler T, Jansen B, Hesse A. Effect of black currant-,cranberry-, and plum juice consumption on risk factors associated with kidney stone formation. Eur J Clin Nutr 2002; 56: 1020–3

    PubMed  CAS  Article  Google Scholar 

  96. 96.

    McHarg T, Rodgers A, Charlton K. Influence of cranberry juice on the urinary risk factors for calcium oxalate kidney stone formation. BJU Int 2003; 92: 765–8

    PubMed  CAS  Article  Google Scholar 

  97. 97.

    Gettman MT, Ogan K, Brinkley LJ, et al. Effect of cranberry juice consumption on urinary stone risk factors. J Urol 2005; 174: 590–4

    PubMed  CAS  Article  Google Scholar 

  98. 98.

    Terris MK, Issa MM, Tacker JR. Dietary supplementation with cranberry concentrate tablets may increase the risk of nephrolithiasis. Urology 2001; 57: 26–9

    PubMed  CAS  Article  Google Scholar 

  99. 99.

    Ross SM. Clinical applications of cranberry in urinary tract infections. Holistic Nurs Prac 2006; 20: 213–4

    Google Scholar 

  100. 100.

    Dugoua J-J, Seely D, Perri D, et al. Safety and efficacy of cranberry (Vaccinium macrocarpon) during pregnancy and lactation. Can J Clin Pharmacol 2008; 15: e80–6

    PubMed  Google Scholar 

  101. 101.

    Nordeng H, Havnen GC. Use of herbal drugs in pregnancy: a survey among 400 Norwegian women. Pharmacoepidemiol Drug Saf 2004; 13: 371–80

    PubMed  Article  Google Scholar 

  102. 102.

    Hodek P, Trefil P, Stiborova M. Flavonoids-potent and versatile biologically active compounds interacting with cytochrome P450. Chem Biol Interact 2002; 139: 1–21

    PubMed  CAS  Article  Google Scholar 

  103. 103.

    Uesawa Y, Mohri K. Effects of cranberry juice on nifedi-pine pharmacokinetics in rats. J Pharm Pharmacol 2006; 58: 1067–72

    PubMed  CAS  Article  Google Scholar 

  104. 104.

    Grenier J, Fradette C, Morelli G, et al. Pomelo juice, but not cranberry juice, affects the pharmacokinetics of cyclosporine in humans. Clin Pharmacol Ther 2006; 79: 255–62

    PubMed  CAS  Article  Google Scholar 

  105. 105.

    Greenblatt DJ, von Moltke LL, Perloff ES, et al. Interaction of flurbiprofen with cranberry juice, grape juice, tea, and fluconazole: in vitro and clinical studies. Clin Pharmacol Ther 2006; 79: 125–33

    PubMed  CAS  Article  Google Scholar 

  106. 106.

    Lilja JJ, Backman JT, Neuvonen PJ. Effects of daily ingestion of cranberry juice on the pharmacokinetics of warfarin, tizanidine, and midazolam — probes of CYP2C9, CYP1A2, and CYP3A 4. Clin Pharmacol Ther 2007; 81: 833–9

    PubMed  CAS  Article  Google Scholar 

  107. 107.

    Suvarna R, Pirmohamed M, Henderson L. Possible interaction between warfarin and cranberry juice. BMJ 2003; 327: 1454

    PubMed  Article  Google Scholar 

  108. 108.

    Grant P. Warfarin and cranberry juice: an interaction? J Heart Valve Dis 2004; 13: 25–6

    PubMed  Google Scholar 

  109. 109.

    Rindone JP, Murphy TW. Warfarin-cranberry juice interaction resulting in profound hypoprothrombinemia and bleeding. Am J Ther 2005; 13: 283–4

    Article  Google Scholar 

  110. 110.

    Paeng CH, Sprague M, Jackevicius CA. Interaction between warfarin and cranberry juice. Clin Ther 2007; 29: 1730–5

    PubMed  Article  Google Scholar 

  111. 111.

    Aston JL, Lodolce AE, Shapiro NL. Interaction between warfarin and cranberry juice. Pharmacotherapy 2006; 26: 1314–9

    PubMed  CAS  Article  Google Scholar 

  112. 112.

    Anonymous. Possible interaction between warfarin and cranberry juice. Curr Probl Pharmacovigil 2003; 29: 8

  113. 113.

    Li Z, Seeram NP, Carpenter CL, et al. Cranberry does not affect prothrombin time in male subjects on warfarin. J Am Diet Assoc 2006; 106: 2057–61

    PubMed  CAS  Article  Google Scholar 

  114. 114.

    Abdul MM, Jiang X, Williams KM, et al. Pharmacodynamic interaction of warfarin with cranberry but not with garlic in healthy subjects. Br J Pharmacol 2008; 154: 1691–700

    Article  CAS  Google Scholar 

  115. 115.

    Lynch DM. Cranberry for prevention of urinary tract infections. Am Fam Phys 2004; 70: 2175–7

    Google Scholar 

  116. 116.

    Bononi M, Tateo F. Stabilization of cranberry anthocyanins in nutraceutical capsules. Int J Food Sci Nutr 2007; 58: 142–9

    PubMed  CAS  Article  Google Scholar 

  117. 117.

    Beerepoot MA, Stobberingh EE, Geerlings SE. A study of non-antibiotic versus antibiotic prophylaxis for recurrent urinary-tract infections in women (the NAPRUTI study). Ned Tijdschr Geneeskd 2006; 150: 574–5

    PubMed  CAS  Google Scholar 

  118. 118.

    Stothers L. Effects of cranberry-containing products in women with recurrent urinary tract infections (UTIs) [ClinicalTrials.gov identifier NCT0010061]. US National Institutes of Health, ClinicalTrials.gov [online]. Available from URL: http://www.clincaltrials.gov [Accessed 2007 Mar 26]

  119. 119.

    McMurdo MET, Argo I, Phillips G, et al. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. J Antimicrob Chemother 2009; 63: 389–95

    PubMed  CAS  Article  Google Scholar 

Download references

Acknowledgements

No funding was provided for the preparation of this article. The author has no conflict of interests that are directly relevant to the content of this review.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr David R.P. Guay.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Guay, D.R. Cranberry and Urinary Tract Infections. Drugs 69, 775–807 (2009). https://doi.org/10.2165/00003495-200969070-00002

Download citation

Keywords

  • Urinary Tract Infection
  • International Normalize Ratio
  • Epicatechin
  • Calcium Oxalate
  • Hippuric Acid