By: Diana Maghanoy Antibiotics are commonly prescribed for efficacious treatment of urinary tract infection and have also been used for prophylaxis of recurrent UTIs. However, its repetitive use is recognised as a factor in the development of multidrug resistance bacteria. Managing recurrent UTIs without inducing multidrug resistance is an important consideration in clinical practice. Due to the common occurrence of recurrent urinary tract infection, recommendations to use diet and lifestyle approaches before prophylactic antibiotics are advocated. Cranberry has been used traditionally to prevent urinary tract infections (UTIs), primarily among generally healthy women prone to recurrent UTIs. Results from a number of published clinical studies have supported this benefit.However, meta-analyses on cranberry and UTI prevention have reported conflicting conclusions (Liska, Kem,& Maki, 2016).
This essay will review 4 journal articles underlining studies conducted to assess the effectiveness of cranberry in woman with recurrent urinary tract infection. In addition, this highlights its implications for nursing practice. Singh, Guatemala, & Kaye(2016) evaluated the property of cranberry extract which is (PAC-A -proanthocyanidin-A) on the in vitro bacterial properties of uropathogenic (E. coli), which is the common cause of UTI. They tested the efficacy in patients with subclinical or uncomplicated recurrent UTI. There were 72 participants and they were divided into 2 groups. Group one received cranberry juice while Group 2 received a placebo.
After 12 weeks of study, they found out that the bacteria growth and adhesion scoring decreased in group I with urine pH reduction and decrease UTI recurrence. The overall efficacy and tolerability of standardised cranberry extract containing (PAC-A) were superior than placebo.In a study conducted by Buxton et.al (2011), 319 college women participants with acute UTI were randomised. 155 were given 8 ounces of cranberry juice twice a day cranberry juice while 164 were given a placebo beverage of the same amount and time. Participants were followed up for 6 months for presenting symptoms and a positive urine culture. Cultures were obtained and it showed a positive result.
The rate of recurrence was 16.9% for the group who drank cranberry presenting a slightly higher recurrence rate. They have concluded that drinking 8oz of cranberry juice per day did not decrease the 6-month incidence of another UTI.
Another study superheaded by Maki et.al. (2016), once again investigated the effectiveness of cranberry juice to women with recurrent UTI. There were 185 women with recent UTI who were assigned to consume one 240 ml serving of cranberry beverage while 185 was on a placebo throughout the 24-week treatment period.The placebo was designed to look, smell and taste like cranberry juice so the participants can’t tell the difference.
The rate of compliance of the cranberry juice consumption was 98%. A clean-catch urine sample was collected, and a clinical (symptomatic) UTI was diagnosed by the investigator based on having ?1 of the following symptoms such as dysuria, urinary frequency and urgency, or suprapubic pain. The rate of recurrence of UTI was recorded. The results revealed 39 participants who had episodes of UTI during the investigation period while 67 episodes in the placebo group. In contrast to the other study, they have concluded that consuming cranberry beverage can lower the number of episodes of recurrent UTI. Takahasi et.
al (2017) examined the rate of relapse in patients with urinary tract infection in Japan. The subjects were aged 20 to 79 years old who were divided into two groups. One group received a cranberry juice (Group 1) while the other got a placebo beverage (Group 2). The colour and taste of the beverages were adjusted so that they can’t identify the placebo. The participants drank a bottle of 125ml once a day before going to bed for 24 weeks.
The result showed a significant difference of rate of incidence of UTI. There were 16 out of 55 participants (29.1%) who had relapse for the Group 1 while there were 31 out of 63 participants (49.2%) in Group 2. They concluded that cranberry juice prevented the recurrence of UTI with the 24-week intake of cranberry juice. Nurses are considered to have a dynamic part in the maintenance of proven interventions and reinforcement of newly discovered treatments depending on the clientele being serviced. As front-liners in the healthcare industry, nurses should be able to educate, lead, introduce and utilise alternative therapies in caring for clients with recurrent urinary tract infection.
In the form of clinical studies and research, nurses can participate actively in contributing to the current body of knowledge with regards to the application of non-pharmacologic treatments. Once a strong reliability on the use of cranberry juice is established, nurses can then promote education and dissemination of information. Currently, there is no clear consensus on the effect of cranberry juice. Although the majority of trials reported protective effects of cranberry products in reducing UTIs, the overall effect is still unclear.
Given that there is some limited evidence to support the cranberry juice efficacy, we can suggest to use cranberry juice as an alternative or supplemental prophylactic approach. However, until further studies can’t confirm its efficacy, cranberry products should not be used in place of antibiotics. Therefore, health care providers must continue to consider patient values, beliefs and preferences in delivering a patient-centred care.