Urol. praxi. 2026;27(2):78-82 | DOI: 10.36290/uro.2026.002

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

MUDr. Marek Broul, Ph.D., MBA, FECSM^{1, 2, 3}, PharmDr. Kateřina Langmaierová⁴, Mgr. Aneta Hujová³, Mgr. Michaela Liegertová, Ph.D.⁵

¹ Sexuologické oddělení, Krajská zdravotní, a. s., Masarykova nemocnice v Ústí nad Labem, o. z.

² Urologické oddělení, Krajská zdravotní, a. s., Nemocnice Litoměřice, o. z.

³ Fakulta zdravotnických studií Univerzity J. E. Purkyně v Ústí nad Labem

⁴ Oddělení klinické farmacie, Krajská zdravotní, a. s., Masarykova nemocnice v Ústí nad Labem, o. z.

⁵ Přírodovědecká fakulta Univerzity Jana Evangelisty Purkyně v Ústí nad Labem

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.

Received: January 15, 2026; Revised: January 20, 2026; Accepted: January 20, 2026; Published: June 10, 2026  Show citation