Cranberry Extract (Vaccinium Macrocarpon) Versus Low-Dose Nitrofurantoin For Preventing Recurrent UTIs In Premenopausal Women

Abstract

Background: Recurrent urinary tract infections are a frequent clinical problem among premenopausal women and often require preventive strategies that balance recurrence reduction with tolerability and antimicrobial stewardship. Low-dose nitrofurantoin is an established prophylactic option, whereas cranberry extract has been proposed as a non-antibiotic alternative because of its potential anti-adhesive effect against uropathogens. Objective: To compare the efficacy and safety of standardized cranberry extract with low-dose nitrofurantoin for prevention of recurrent urinary tract infections among premenopausal women. Methods: A parallel-group randomized controlled trial was conducted among 80 premenopausal women aged 18–45 years with recurrent urinary tract infections. Participants were randomized to receive either cranberry extract containing 36 mg proanthocyanidins once daily or nitrofurantoin 50 mg once daily for 12 weeks. Outcomes included symptomatic culture-confirmed UTI episodes, time to first recurrence, urinary symptom severity measured by VAS, adherence, and adverse events. The final completer analysis included 72 participants. Results: Mean UTI episodes were lower with nitrofurantoin than cranberry extract (0.38 ± 0.49 vs 0.74 ± 0.65; mean difference 0.36, 95% CI 0.10–0.62; p=0.01). Time to recurrence was longer with nitrofurantoin (10.2 ± 2.1 vs 8.4 ± 2.5 weeks; p=0.003), and VAS reduction was greater (-4.6 ± 1.3 vs -3.6 ± 1.5; p=0.004). Adverse events were numerically higher with nitrofurantoin (27.0% vs 11.4%). Conclusion: Nitrofurantoin provided greater short-term prophylactic efficacy, whereas cranberry extract showed better numerical tolerability and may be considered for selected women prioritizing non-antibiotic prevention.