D-mannose and urinary tract
What 8 graded rows on d-mannose agree on for urinary tract, and where they differ. Counted side by side, never averaged.
Consensus finder Rows from the D-mannose page, reviewed Oct 21, 2026 How it decides
What the rows agree on
Each block and row is one graded row from the D-mannose page, with its PubMed record.
Your question
D-mannose and urinary tract
8 rows · 3,380 peopleSplit. 2 rows found an improvement, 3 found no difference and 3 had mixed results.
- CGrade C× 3
- DGrade D× 4
- ∅No effect× 1
- Rows
- 8
- Trials
- 23
- People
- 3,380
- Pooled reviews may count some twice
Where they differ
From the rowsThe best-graded row, grade C, is a meta-analysis of 1,167 people (2025) and found no difference. 1 row is graded No effect, our grade for adequately powered trials that found no effect.
The 3 rows that found no difference were larger: a median of 583 people, against a median of 278 people for the 2 rows that found an improvement.
The 3 rows that found no difference are newer (2023 to 2025) than the 2 rows that found an improvement (2014 to 2020).
3 rows with mixed results are left out of this comparison.
The rows
2 improved · 3 no difference · 3 mixed- CGrade CRecurrent UTI (pooled RCTs, incl. the 2024 UK trial) · No difference
Meta-analysis, 6 studies · n 1,167 · 2025 · 6 RCTs of people at high risk of recurrent UTI; 97.6% of D-mannose recipients were women
Varied by trial · Varied
No significant reduction in recurrent UTI vs control (RR 0.57, 95% CI 0.29–1.15) or vs antibiotics (RR 0.39, 95% CI 0.12–1.25); no benefit in the postmenopausal subgroup.
- DGrade DRecurrent UTI in postmenopausal women using vaginal estrogen · No difference
RCT · n 44 · 2023 · Postmenopausal women with recurrent UTI on vaginal estrogen (USA)
2 g/day · 90 days
Cumulative UTI incidence 41.1% with D-mannose vs 50.4% with control (HR 0.76, 99.9% CI 0.15–3.97); the trial was stopped early after a futility analysis.
- ∅No effectRecurrent UTI in women in primary care · No difference
RCT · n 583 · 2024 · Women 18+ with recurrent UTI in 99 UK primary care centres (598 randomized)
2 g/day · 6 months
A clinically suspected UTI occurred in 51.0% vs 55.7% (risk difference −5%, 95% CI −13% to 3%; P = 0.26); no secondary outcome differed.
- CGrade CRecurrent UTI vs nitrofurantoin and no prophylaxis · Improved
RCT · n 308 · 2014 · Croatian women with recurrent UTI after treatment of acute cystitis
2 g/day in 200 mL water (vs nitrofurantoin 50 mg/day) · 6 months
Recurrence 14.6% with D-mannose, 20.4% with nitrofurantoin and 60.8% with no prophylaxis (RR 0.239 vs no prophylaxis); side effects were mild and less frequent than with nitrofurantoin.
- DGrade DRecurrent UTI vs placebo or antibiotics (early studies) · Improved
Systematic review, 8 studies · n 248 · 2020 · Adult women; pooled D-mannose vs placebo comparison
Varied by study · Varied
Pooled RR vs placebo 0.23 (95% CI 0.14–0.37) from small early studies; vs preventive antibiotics RR 0.39 (95% CI 0.12–1.25, not significant).
- CGrade CRecurrent UTI (pooled RCTs) · Mixed
Meta-analysis, 4 studies · n 890 · 2025 · Adult women in 4 RCTs
Varied by trial · Varied
Recurrent UTI RR 0.44 (95% CI 0.18–1.11; P = 0.082; I² 90%); adverse events did not differ significantly.
- DGrade DSymptom resolution in acute uncomplicated cystitis vs fosfomycin · Mixed
RCT · n 111 · 2026 · Women aged 18–70 with acute uncomplicated cystitis (Germany)
2 g three times daily on days 1–3, then twice daily on days 4–5 (vs fosfomycin 3 g once) · 5 days, assessed to day 8
Cure rate on day 8 was 10.1 percentage points lower with D-mannose; non-inferiority was not statistically confirmed (only a post hoc analysis showed comparability). Median time until symptoms resolved 5.0 vs 3.0 days; GI adverse events 9.8% vs 24.6%.
- DGrade DAcute UTI symptoms over 3 days vs placebo · Mixed
RCT · n 29 · 2026 · Women aged 18–75 with uncomplicated UTI symptoms and a positive urine dipstick (Canada)
1.5 g twice daily (3 g/day) · 3 days
Total symptom severity did not differ; bother scores were lower by day 3 (p = 0.027) and more women had complete resolution of urinary frequency on day 4 (43% vs 20%).