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Women are more prone to urinary tract infections than men, in part because of their shorter urethras. You’ve probably heard that drinking cranberry juice can be helpful in supporting a healthy urinary tract. What many studies fail to mention is that most cranberry juice is loaded with fructose, a monosaccharide (simple sugar) that can potentially lead to health problems.
So, in effect, you are trading good urinary health for blood sugar instability, stress on your liver, and increased uric acid levels that can raise your blood pressure, along with other negative health sequelae.
But there is a great discovery that has come from the cranberry juice-urinary tract connection.
Why drink sugary cranberry juice if you can get the active ingredient instead, with none of the damaging metabolic consequences? The condition euphemistically called “Honeymoon Cystitis” is now preventable—no abstinence required. Your body absorbs D-mannose much more slowly than glucose, and the D-mannose does not convert to glycogen or get stored in your liver.
Most of the D-mannose is filtered through your kidneys and routed to your bladder, then quickly excreted in your urine.
D-mannose helps to nourish your healthy flora because it doesn’t affect “friendly” bacteria.
When you take antibiotics for a urinary tract infection (UTI), the good bacteria are killed along with the bad, which is why you can develop secondary yeast infections and digestive problems.
You might be wondering, if the bacteria are in my urine, why doesn’t my body simply flush them out when I urinate? These little fingerlike projections are made of an amino acid-sugar complex, a glycoprotein called lectin, which makes them sticky. Lectin on the bacteria’s fimbria binds to mannose, which is produced by your cells and covers the internal lining of your urinary organs. Unable to resist the tasty bait they suddenly find themselves swimming in, they would latch onto the nearest mannose molecules, and happily sail off into the porcelain sunset. Physicians who employ natural therapies have been using D-mannose since the mid-1980s with great success.
Research in humans shows that ingesting D-mannose significantly raises blood mannose levels, which is what is needed to raise urinary mannose levels. Antibiotics kill the good bacteria, along with the bad, as described earlier, setting you up for fungal infections, diarrhea, and other digestive trouble.
Antibiotic treatment does not successfully kill all the bacteria participating in the infection and may, in fact, encourage many of the bacteria to persist in a resting state. Using unnecessary antibiotics with children prevents them from developing their own natural defenses as their immune systems mature. Physicians often prescribe newer, very expensive antibiotics for UTIs instead of “old gold standards,” which is a strain on your pocketbook.
The majority of urinary tract infections can be cured when symptoms first arise, or prevented altogether by following these home remedies for kidney infection outlined in this article. Urinary tract infections can affect any part of your urinary tract, but the lower urinary tract is far more common—specifically, your bladder (cystitis) and urethra (urethritis).
Kidney infections can cause permanent kidney damage and kidney failure if not promptly resolved, or can spread to your bloodstream. If you do use an antibiotic, it is important to take a high quality, high potency probiotic to replace the beneficial bacteria killed by the antibiotic. Research shows that frequent consumption of products containing probiotic bacteria can promote good urinary tract health—fermented foods such as kefir, sauerkraut and other fermented vegetables are great for your overall health—including your urinary system. Over the past year, my friend Dave at PaleoHacks has been working on a secret cookbook with world-renowned Le Cordon Bleu chef Peter Servold.
In the years running Healthy Holistic Living, I have come to the realization that empowering yourself with information is the key good health. On a monthly basis, I will be updating this list in an effort to provide you with resources to help you along the way. Our New BMJ website does not support IE6 please upgrade your browser to the latest version or use alternative browsers suggested below.
Adult men have another factor going for them—a bacterial growth inhibitor injected directly into their urinary system2 by their prostate glands. The active ingredient in cranberry juice responsible for its benefit to your urinary system has been identified and isolated—and that is D-mannose. Pure D-mannose is amazingly 10-50 times stronger than cranberry, non-toxic and completely safe, with NO adverse effects.
It’s a naturally occurring sugar, closely related to glucose and you even produce it in your body.
Only very small amounts of D-mannose are metabolized, so it doesn’t interfere with blood sugar regulation.

Laboratory studies have now confirmed what these physicians and patients have known for many years. If you suspect you have a kidney infection—especially if you have a fever—it might be necessary to see a physician and employ an antibiotic so the infection does not spread to your kidney and cause some very serious problems. Once in a while, a UTI can progress up to the kidneys (nephritis or pyelonephritis), which is a more serious infection and warrants a trip to your health care provider.
I encourage all of you to take back your power and gain the knowledge you need to live the fullest, healthiest and happiest life possible. And very importantly, it does NOT produce the metabolic stresses that fructose does because it’s more like glucose, which every cell in your body is designed to use.
Problems only arise when this ordinary bacterium is present in high numbers in places where it shouldn’t be—like your urinary system. For example, if you take your antibiotic at 8am and 8pm, take your probiotic at 2pm to minimize the effects from the antibiotic.
Studies were heterogeneous in the type and duration of antimicrobial prophylaxis and the period of observation.
Overall, antibiotic prophylaxis was associated with benefit to the patient, with an absolute reduction in risk of urinary tract infection of 5.8% between intervention and control groups. The number needed to treat to prevent one urinary tract infection was 17 (12 to 30).Conclusions Patients admitted to hospital who undergo short term urinary catheterization might benefit from antimicrobial prophylaxis when the catheter is removed as they experience fewer subsequent urinary tract infections. Potential disadvantages of more widespread antimicrobial prophylaxis (side effects and cost of antibiotics, development of antimicrobial resistance) might be mitigated by the identification of which patients are most likely to benefit from this approach.IntroductionUrinary catheterization is common in patients in hospital, particularly for surgical patients in the perioperative period when physiological mechanisms of bladder emptying are suspended. Randomized trials have yielded conflicting results,7 8 and there has been no meta-analysis. First, we performed a systematic review of randomized and non-randomized controlled trials that compared antibiotic prophylaxis with placebo or a control group at the time of removal of a transurethral urinary catheter and tracked the occurrence of symptomatic urinary tract infections in the subsequent period (JM). For this purpose, we screened the medical literature in PubMed from 1947 up to November 2012 with the search terms urinary catheter, removal, prophylaxis, antibiotic prophylaxis randomized, and trial, and evaluated conference abstracts from 2006-2012 (from Infectious Diseases Society of America (IDSA) annual meeting, Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Society for Healthcare Epidemiology of America (SHEA) annual meeting, and the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID)). Next, a medical librarian (SF) created a systematic search strategy that included a combination of standardized index terms and straight keywords. She ran that search in Embase, Scopus, the Cochrane Library (including CENTRAL), and, in addition to PubMed.
We reviewed the reference lists of all potentially relevant studies to identify additional research data. We included non-English language and unpublished studies (fig 1).?Fig 1 Selection of studies for meta-analysis of trials investigating antibiotic prophylaxis for urinary tract infections after removal of urinary catheterEligible studies were randomized and non-randomized controlled trials of short term catheterization in adults with symptomatic urinary tract infection as an endpoint.
The endpoint of symptomatic urinary tract infection required the detection of measureable bacteriuria plus the presence of at least one symptom or sign compatible with urinary tract infection.2 Not all studies, however, specified which clinical criteria were fulfilled for this endpoint. We did not include the endpoint bacteriuria because antibiotic treatment of asymptomatic bacteriuria is not indicated.12 Because antibiotic prophylaxis was directed specifically at the prevention of symptomatic urinary tract infections, we did not assess additional outcomes such as survival. Subsequent symptomatic urinary tract infections caused by antibiotic resistant organisms would have been a meaningful secondary endpoint but none of the included studies assessed it.One reviewer (JM) screened the titles and abstracts of eligible studies originating from the primary search. Two independent reviewers (JM, BWT) screened the titles and abstracts of eligible studies identified in the secondary search. Potentially relevant papers were obtained, and these reviewers assessed the full manuscript for possible inclusion.
There were no restrictions with regard to the antibiotics used for prophylaxis or the length of follow-up after antibiotic prophylaxis in the reviewed studies.Data extraction and meta-analysisWe extracted information about the study design, inclusion criteria for patients, sample size, antimicrobial agents used for prophylaxis, and the duration of administration. We also noted the duration of catheterization until removal in intervention and control groups.
A priori, both investigators agreed to evaluate selection bias based on adequacy of randomization and allocation concealment for each study, while performance bias was judged on the probability for systematic differences in care after randomization. Investigators judged attrition bias based on any systematic difference in withdrawals between intervention and control groups. Detection bias was assessed on the timing and methods used to ascertain the primary outcome for each study. The reliability of quality assessment between raters was evaluated with Cohen’s ?,14 with the statistical package SPSS version 20 (IBM Corporation, Armonk, NY). Heterogeneity among the studies was assessed with ?2 and I2 statistics (25%, 50%, and 75% representing low, moderate, and high heterogeneity).15 We pooled the results of studies using random effects models, if appropriate, after consideration of heterogeneity among trials. We calculated individual and pooled statistics as relative risks and 95% confidence intervals. We conducted a sensitivity analysis of the pooled relative risk by sequentially excluding the non-randomized study and the unpublished study from the analysis.
We also performed subgroup analyses of studies in surgical patients and mixed hospital populations. We evaluated potential publication bias with a funnel plot.16ResultsThe two literature searches identified 246 and 221 potentially relevant abstracts (fig 1?).
In the primary search, we identified 27 abstracts that led to full article review and two further studies by reviewing bibliographies or through conference abstracts.

In the secondary search, two reviewers independently determined that 17 of 221 abstracts required review of the full manuscript. Three trials indicated that prophylaxis is associated with lower incidence of urinary tract infection,7 26 29 whereas three published studies8 25 27 and the single unpublished randomized study28 did not report any benefit with prophylaxis. The quality of the included studies was variable: there was a low risk of detection bias and performance bias and a high risk of selection and attrition bias in most studies. For the detection bias, we could not calculate ? because one rater’s assessment was constant across studies (that is, ?=0). The one non-randomized prospective study evaluated antibiotic prophylaxis in 729 consecutive patients who underwent laparoscopic radical prostatectomy. Additionally, the numbers of urinary tract infections in the various arms in the study reported by Harding and colleagues26 were difficult to discern from the published text and were therefore confirmed via email with one of Harding’s coauthors (L Nicolle, personal communication). Alternative explanations for asymmetry include heterogeneity between studies with the intervention fidelity or outcome assessment, as well as improved standard of care in the control groups as routine management evolves over time, which reduces the observed effect size.
Current practice and variation in study designsAdministration of prophylactic antibiotics at the time of removal of a catheter might already be common practice, particularly among urologists.
Certain populations of patients, however, are most likely to benefit from antibiotic prophylaxis on catheter removal, and prophylaxis should be focused on these groups, as acknowledged in the AUA guidelines.10 Future studies should attempt to identify specific populations at risk for the development of urinary tract infections after catheter removal that would be appropriate targets for antibiotic prophylaxis.
Also, the results of our meta-analysis are largely driven by data on surgical patients and short term urinary catheters.
Only two studies included non-surgical patients,26 27 and their pooled findings indicated no significant difference between intervention and control group.
Additional studies should examine medical patients, including those living in long term care facilities, who might be catheterized for longer. Lastly, the benefit of preventing urinary tract infections should be carefully weighed against the additional cost to the hospital of prophylactic antibiotics, the potential for adverse antibiotic effects, and the impact on resistance patterns of uropathogens. Stochastic modeling and cost effectiveness analyses might be ways to guide future decision making.Limitations inherent to this meta-analysis include the potential for publication bias, although we also included unpublished abstracts in our search. Furthermore, the included studies were distinctly different in design—with diverse populations of patients, choices of antibiotics, durations of prophylaxis, and a heterogeneous observation period after removal of the catheter—so that standardized recommendations are difficult to make.
The largest included study was not randomized but instead compared patients of surgeon A (who gave prophylactic antibiotics) with patients of surgeon B (who did not give prophylactic antibiotics); these surgeons’ practices and techniques could have differed in many other ways.
Also, some of the studies did not use a placebo in the control arm, and patients’ assessment and reporting of urinary symptoms could have been affected by their knowledge of treatment status.
Lastly, only two of the included studies recorded information on adverse events associated with the antibiotics, such as drug toxicities, allergic reactions, or infections with Clostridium difficile.7 27 None of the studies looked at the costs of antibiotic prophylaxis or at emerging antimicrobial resistance.
Clinicians must assimilate these uncertainties when weighing advantages and disadvantages of implementing antibiotic prophylaxis after urethral catheterization.ConclusionsThis meta-analysis of available data indicates an overall benefit of antibiotic prophylaxis at the time of removal of a urinary catheter to prevent subsequent urinary tract infections. The number needed to treat indicates that 17 patients would need to receive prophylaxis to prevent one symptomatic urinary tract infection.
We know little, however, about the potential negative consequences of implementing antibiotic prophylaxis in this setting in a wider frame or indeed which types of patients would be most likely to benefit. Increasing antimicrobial resistance, healthcare costs for antibiotics, and the potential for side effects of antibiotic administration are disadvantages that merit careful review.
From a public health standpoint, we should be careful not to encourage antibiotic use when it might not be necessary.
The healthcare provider of a catheterized patient, however, might consider antibiotic prophylaxis before catheter removal, after taking individual risk factors into account. BWT was funded during the time of manuscript preparation by a VA Career Development Award from rehabilitation research and development (B4623), by VA HSR&D IIR 09-104, and NIDDK R21 092293.
BWT’s work is also partially supported by the resources and facilities at the Houston VA Health Services Research and Development Center of Excellence (HFP90-020) at the Michael E DeBakey VA Medical Center. JM received support from the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) award through the NIH NCATS, a career development award (5K12HD001459-13). He is also the section leader for a subproject of the CDC Prevention Epicenters Program grant (U54 CK000162; PI Fraser). Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America.
Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Is there a role for prophylactic antibiotics in the prevention of urinary tract infections following Foley catheter removal in patients having abdominal surgery? Fever, bacteremia, and death as complications of bacteriuria in women with long-term urethral catheters. Antibiotic prophylaxis at urinary catheter removal prevents urinary tract infections: a prospective randomized trial.

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08.06.2014, author: admin

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