Clinical Scenario
An 87 year old white female patient presents to the clinic with her son. According to the
patient’s son, the assisted living facility reported that his mother had an increase in confusion,
frequency, urgency, and dysuria for the past week. Urine: positive for leukocytes (TNTC) and
bacteria (3+). Results indicate a urinary tract infection (UTI). The urine culture indicates E coli
> 100,000 cfu/ml. The patient has had four UTIs in the last six months. With each UTI, she has
had acute delirium and combativeness. The patient has an allergy to sulfa medications. The
patient has a medical history of multiple sclerosis, dementia, stage three renal failure, and heart
failure.
Clinical Question
Among women with frequent urinary tract infections, are cranberry products effective in the
prevention of UTIs when compared to a placebo?
Articles
Howell, A.B., Botto, H., Combescure, C., Blanc-Potard, A., Gausa, L., Matsumoto, T., Tenke, P,
Sotto, A., & Lavigne, J. (2010). Dosage effect on uropathogenic Escherichia coli antiadhesion activity in urine following consumption of cranberry powder standardized for
proanthocyanidin content: a multicentric randomized double blind study. BMC infectious
disease, 10(94). doi: 10.1186/1471-2334-10-94.
Jepson, R.G. & Craig, J.C. Cranberries for preventing urinary tract infections. Cochrane
Database of Systematic Reviews 2008, Issue 1. Art. No.: CD001321. doi:
CRANBERRY PRODUCTS AND THE PREVENTION OF URINARY TRACT INFECTIONS 2
10.1002/14651858.CD001321.pub4.
Summary and Appraisal of Key Evidence
Study 1 Howell et.al., (2010) completed a multi-location randomized, double-blind versus
placebo study to evaluate whether cranberry powder can be utilized in the prevention of UTIs by
inhibiting bacterial adhesion and virulence in the urinary tract, providing Level 1, Grade A level
of evidence. Study participants included-32 women from Japan, Spain, France, and Hungary.
The women were sexually active, over the age of 18, and demonstrated normal renal function.
Participants were excluded if they had been on antibiotic therapy in the last 6 months, had an
allergy or intolerance to cranberry products, were pregnant, or routinely consumed food
supplements which had vitamins, minerals or trace elements. The study did not include the ages
of the women, and it cannot be assumed that the elderly population is represented in this study.