A. Lenore Ackerman, MD, on D-mannose for UTI prophylaxis

A recent amendment to the American Urological Association’s guideline on recurrent uncomplicated urinary tract infections (uUTIs) in women suggests that D-mannose alone may not be effective for UTI prophylaxis.¹ In a recent interview with Urology Times®, guideline amendment chair A. Lenore Ackerman, MD, PhD, outlined that data supporting this recommendation.

Ackerman is a urogynecologist at the University of California, Los Angeles.

“This aspect of the guidelines was not meant to discourage people from using it,” Ackerman explained. “If they have been using it and using it successfully, there's no reason that they cannot continue to do so.”

However, Ackerman did acknowledge a recent clinical trial that showed a lack of benefit with D-mannose compared with the comparator arm.

She added, “We felt like we needed to say something [acknowledging that] it isn't on that same plane with cranberry [or] methenamine, and we shouldn't be advising people to use it as their only form of prophylaxis due to the fact that this accumulation of data seems to suggest that, at best, the data is equivocal, and at worst, if this more recent randomized trial is accurate, it may not really be doing much at all.”

Ackerman also noted that D-mannose may be used in combination with other prophylactic options to improve efficacy.

REFERENCE

1. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025). American Urological Association. Accessed September 4, 2025. https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti