MANCOIT study: Pilot study on the prevention of recurrent postcoital urinary tract infection in women with d-mannose plus proanthocyanidins (PAC).

INTRODUCTION

Urinary tract infections (UTIs) are common among women, and approximately 20-30% experience recurrent episodes (rUTIs). The increasing prevalence of antimicrobial resistance highlights the need for non-antibiotic preventive strategies. d-mannose and proanthocyanidins (PAC) have shown potential in reducing rUTIs. The aim of this study was to evaluate the efficacy of a combination of d-mannose and PAC in preventing postcoital UTIs over a 6-month period.

MATERIALS AND

METHODS

We conducted a prospective, single-center pilot study including 26 women aged 18-45 years with a history of recurrent postcoital UTIs. Participants received a daily prolonged-release formulation containing d-mannose (2000 mg) and PAC (140 mg) for 6 months. The primary outcome was the incidence of postcoital UTI episodes. Secondary outcomes included treatment adherence, episode severity, microbiological findings, safety, quality of life, and patient-reported improvement. Analyses were performed on both the intention-to-treat (ITT) and per-protocol (PP) populations.

RESULTS

At 6 months, 53.6% of participants had no new UTI episodes. A total of 24 episodes were recorded in 12 women, with more than two-thirds concentrated in a small subgroup. Overall, UTI incidence decreased significantly (p = 0.01), and 76.2% of participants remained infection-free at the final visit. Adherence was high (90.9% at 3 months and 85.7% at 6 months). Positive urine cultures most frequently identified Klebsiella aerogenes and Escherichia coli. Sexual function remained stable, and 80.9% of women reported subjective improvement. Only one withdrawal occurred due to vaginal dryness.

CONCLUSIONS

The combination of d-mannose and PAC in a prolonged-release formulation appears to be a promising, safe, and well-tolerated strategy for the prevention of postcoital rUTIs in young women. Larger randomized controlled trials are warranted to confirm these preliminary findings.