Urologie pro praxi 2/2026

D-mannose in urinary tract infections: mechanistic rationale, clinical effectiveness, and limitations of evidence

Recurrent cystitis in women is a frequent outpatient urology problem, substantially impairing quality of life and increasing antibiotic exposure with consequences for antimicrobial resistance and microbiome disruption (1, 2). D-mannose is widely used as an antibiotic-sparing option supported by a plausible anti-adhesive mechanism, potentially blocking the binding of uropathogenic Escherichia coli to urothelium via the FimH adhesin (4, 5). However, clinical evidence remains heterogeneous. While earlier studies and some reviews suggested a possible prophylactic benefit (6–8), a large pragmatic placebo-controlled randomized trial in primary care did not demonstrate a clinically relevant preventive effect (9). Recent systematic reviews report low certainty of evidence (10, 11), and contemporary guidelines therefore consider D-mannose only an optionalims optional adjunct with explicit patient counselling about weak and contradictory evidence and shared decision-making (2, 12). This review summarizes mechanisms, clinical evidence, safety, and provides a pragmatic outpatient algorithm, including differential diagnosis of postcoital dysuria and non-infectious symptom phenotypes.

Keywords: D-mannose, recurrent cystitis, non-antibiotic prophylaxis, anti-adhesion therapy, FimH.