Urinary tract infections (UTIs) are a common problem, especially among women. An imbalance of urogenital bacteria caused by frequent sexual intercourse or postmenopausal age is a risk factor for UTIs. Frequent infections and the use of antibiotics lead to changes in the urogenital microbiota. In particular, the use of antibiotics may influence the prevalence of indigenous lactobacilli and potentially create a suitable environment for the proliferation of uropathogens. At the same time, antibiotic resistance is becoming an increasingly serious problem in medicine, especially in the prevention and treatment of recurrent UTIs. In this regard, the search for new alternative approaches becomes a necessity. One such potential solution is the use of D-mannose. D-mannose is a monosaccharide, a natural aldohexose sugar, distinguished from glucose by the inversion of one of the 4 chiral centers of the molecule: the carbon atom in the second position. This sugar is physiologically present in the human body, participates in immunoregulation and plays other important biological roles such as glycosylation of many proteins. Another property of D-mannose has been discovered: it inhibits bacterial adhesion to the urothelium. It is a key component of glycoproteins that play an important role in normal urinary tract function. A systematic analysis of 33,064 studies by I.Yu. Torshin et al. in 2020 showed other significant effects of D-mannose: its importance for protein glycosylation, supporting the immune, cardiovascular, urinary and other body systems. Disorders of D-mannose metabolism are integral component of the pathogenesis of autoimmune diseases (type 1 diabetes mellitus, Crohn’s disease, rheumatoid arthritis, etc.). In addition, disturbances in the levels and activity of D-mannose-dependent proteins are associated with an increased risk of bacterial cystitis and tumor pathologies. The analyzed literature also demonstrated that the bacteriostatic, anti-inflammatory and antitumor effects of D-mannose are enhanced by the prebiotic (metabiotic) inulin. In combination with inulin, D-mannose inhibits the growth of pathogenic bacteria and simultaneously supports the growth of beneficial intestinal microbiota. We reviewed the literature to evaluate the effect of D-mannose in the prevention of recurrent UTIs.

Keywords: Cystalis, D-mannose, Escherichia coli, antibiotic resistance, urinary tract infections