Author Year Country | Methods | Outcome |
Hess et al. 2008 USA PEDro=9 RCT N=47 | Population: Mean age: 53 yr; Gender: males=47, females=0; Level of injury: tetraplegia=23, paraplegia=24; Severity of injury: AIS A=27, B=10, C=10 Intervention: SCI individuals with neurogenic bladder were divided into two groups. Each group was randomly selected to receive either 6 mo of cranberry extract tablet 500 mg BID, or placebo and then the alternate for the next 6 mo. Bladder management methods: condom catheter=35, intermittent catheterization (IC)=8, and indwelling catheter=4. Outcome Measures: Incidence of urinary tract infection (UTI) (>104 organisms, one+new symptoms, evidence of tissue invasion – hematuria or pyuria; urine pH. | 1. No significant difference was seen between the two groups in the incidence of bacteriuria; however UTI were fewer in the period of cranberry treatment (7 UTI/6 mo) versus placebo (21 UTI/6 mo) (p=0.01). 2. 34% of individuals in the placebo period experienced at least one UTI; while only 13% experienced at least one UTI in the cranberry tablet consumption period (p=0.03). 3. Urine pH was not significantly different between the two periods. 4. The 22 participants with a high glomerular filtration rate (GFR) reported no incidence of UTIs during the cranberry period, while 9 had 11 UTIs during the placebo period. |
Lee et al. 2007 Australia RCT PEDro=7 N=305 | Population: SCI with Neurogenic bladder and stable management: Mean age: 43.5 yr; Gender: males=253, females=52; Level of injury: tetraplegia=168; Severity of injury: complete=150 Intervention: Double-blinded comparison of methenamine hippurate (MH, 2g) with cranberry (1600mg), MH (2g) with cranberry placebo, cranberry (1600mg) with MH placebo or MH placebo with cranberry placebo). Outcome Measures: Time to symptomatic urinary tract infection (UTI) (culture), predictors of UTIs, adverse events collected for up to 6 mo. | 1. The Kaplan-Meier curves for MH and Cranberry compared to placebo showed no evidence of a treatment effect. 2. The unadjusted analysis confirms that there was no statistically significant effect of MH tablets (HR 0.94, 95% confidence interval 0.68-1.32) or cranberry tablets (HR 0.93, 95% CI 0.66-1.29). 3. The only significant predictor of a future UTI was found to be the number of UTIs in the preceding 6 mo. 4. Common adverse effects included diarrhea or constipation. 5. There was no difference in adverse event rates between the groups. |
Linsemeyer et al. 2004 USA RCT PEDro=6 Ninitial=37; Nfinal=21 | Population: SCI with neurogenic bladder: Gender: males=16, females=5; Level of injury: C4-L1; Number of UTIs=0 to 2. Intervention: Randomized, crossover: placebo or cranberry tablets (400 mg) 3 times daily for 4 weeks. Outcome Measures: Urinary bacterial counts, white blood cell counts, combination of both counts. | 1. No statistically significant findings for the effect of cranberry tablets versus placebo: · Urinary bacterial count (p=0.96), · White blood cell count (p<0.27)or · Urinary bacterial + white blood cell count combination (p<0.27). |
Waites et al. 2004 USA RCT PEDro=5 Ninitial=74; Nfinal=48
| Population: SCI with neurogenic bladder: Age range 20-73 yr; Gender: males=42, females=6; Severity of injury: complete=40, incomplete=6; Time post-injury=1-30 yr. Intervention: Randomized to cranberry versus placebo capsules. Outcome Measures: Bacterial counts and urinalysis. | 1. No significant differences between groups: · Bacterial colony counts, bladder management method, or within groups over time (p=0.758). · Urinary leukocyte counts /mL urine, bladder management method, or within groups over time (p=0.929). · pH of urine, or within groups over time (p=0.659). · For each outcome, no interaction between groups, bladder management method, and time (p>0.05). 2. pH higher for external collection versus intermittent catheter (p=0.046) for all time periods for both groups combined. |
Pannek et al. 2018a Switzerland Prospective Controlled Trial NInitial=46 NFinal=35
| Population: Homeopathy (HT): Median age=23.9yr (3.6 – 49.9); Gender: males=16, females=9; Etiology: SCI=25; Median time since injury=13.8yr (1.4 – 45.0). Control (CG): Median age=47yr (37 – 73); Gender: males=7, females=3; Etiology: SCI=10; Median time since injury=22.0±13.9yr. Intervention: Participants were allocated to either HT or CG. CG consisted of the standard of practice at the authors’ institution which consisted of urine acidification with either L-methionine, 3×500 mg, or one teaspoon of cider vinegar in 1 glass of water with cranberry extracts 3x daily. Participants in the HT group received one of 6 different homeopathic remedies; Staphysagria, Nux-vomica, Lycopodium clavatum, Hypericum, Sulpher, and Acidum nitricum. Outcomes measures were assessed at baseline and 1x/mo, for 4 yr. Outcome Measures: UTIs per yr. | 1. HT was more effective for prophylaxis of UTI compared to CG (p<0.001). 2. HT showed a significant decrease in the number of UTIs per year at the end of the study compared to the pre-study rate (p<0.001). 3. There was no significant difference in UTI rate when comparing pre- and post-study for the CG (p>0.05). |
Pannek et al. 2018b Switzerland Prospective Controlled Trial NInitial=46 NFinal=35
| Population: Homeopathy (HT): Median age=23.9yr (3.6 – 49.9); Gender: males=16, females=9; Etiology: SCI=25; Median time since injury=13.8yr (1.4 – 45.0). Control (CG): Median age=47yr (37 – 73); Gender: males=7, females=3; Etiology: SCI=10; Median time since injury=22.0±13.9yr. Intervention: Sub-analysis of Pannek et al. 2018a. Data was organized relative to UTI treatment to assess antibiotic vs non-antibiotic treatment success rate. Antibiotic treatment methods included; Ciprofloxacin, Nitrofurantoin, Norfloxacin, other. Non-antibiotic treatment methods included; homeopathy (Staphysagria, Lycopodium clavatum, Hypericum, Nux vomica, Sulphur, Acidum nitricum), Bladder tea, bladder irrigation with saline, cranberry products, increased fluid intake. Outcome Measures: Treatment success rate. | 1. There was no difference antibiotic and non-antibiotic success rates (p>0.05). |
Reid et al. 2001 Canada Pre-Post N=15 | Population: SCI: Age range 21-78 yr; Gender: males=10, females=4, not determined=1. Intervention: 250 mL water and cranberry juice with meals successively, each for 7 d treatment arms separated by 2 days. Outcome Measures: Biofilm load, bacterial adhesion collected at 0, 7 and 15 days, gram negative counts. | Cranberry juice versus water significantly reduces: 1. Biofilm load (p=0.028); and compared to baseline (p=0.013,). 2. Bacterial Adhesion counts (p<0.033). 3. Gram positive counts (p=0.022). 4. Gram negative counts (p=0.054). |
Pannek et al. 2014 Switzerland Case Series N=8 | Population: Neurogenic lower urinary tract dysfunction; Mean age: 38.75 yr; Gender: males; Level of injury: cervical=3, thoracic=5; Severity of injury: complete=4, incomplete=4. Intervention: In addition to standard urologic prophylaxis consisting of 4 mo antibiotic treatment (Nitrofuracin or Trimethoprim) and urine acidification with L-Methionine and Cranberry tablets (twice/day), individuals underwent homeopathic case taking by experienced homeopaths. Outcomes: Description of cases, UTI frequency, adverse events, reduction of standard treatment. | 1. At a median follow-up of 15 mo, 5 participants did not experience new UTIs, and UTI frequency was reduced in 3 participants. 2. Standard prophylactic treatment could be reduced in 4 participants. 3. No side effects or adverse drug reactions were observed. 4. Bladder management and standard prophylactic measured remained unchanged for all participants. |