Antimicrobial Potential of Cranberry Proanthocynin in Urinary Tract Infections: A Literature Review

Abstract

Urinary tract infections (UTIs) are among the most prevalent bacterial infections, particularly affecting women, pregnant individuals, and children, and are often complicated by increasing antimicrobial resistance. This review evaluates the potential role of cranberry (Vaccinium macrocarpon) and its bioactive constituents, primarily A-type proanthocyanidins (PACs), in the prevention and adjunctive management of UTIs. Cranberry PACs exhibit a unique mechanism by inhibiting the adhesion of P-fimbriated Escherichia coli to uroepithelial cells, thereby reducing bacterial colonization. In addition, cranberries possess antimicrobial, antioxidant, and anti-inflammatory properties that further contribute to urinary tract health. Clinical studies show variable but promising results, especially in women with recurrent UTIs, with some trials demonstrating reduced recurrence rates when cranberry juice or extracts were consumed regularly. Pharmacokinetic studies indicate limited oral bioavailability of PACs, but their metabolites are excreted in urine where they exert local effects. Cranberry products are generally safe; however, potential drug interactions, particularly with warfarin, should be considered. This review concludes that cranberry may serve as an effective, non-antibiotic prophylactic option for recurrent UTIs, but standardized dosing, long-term safety, and high-quality clinical evidence remain areas for further research.

Introduction

Urinary Tract Infection (UTI) is a common condition affecting the urethra, bladder, and kidneys, with women being more susceptible due to anatomical and physiological factors, including pregnancy. UTIs in children are clinically significant, as renal scarring can lead to long-term complications like end-stage renal disease. UTIs are classified by site (urethritis, ureteritis, cystitis, pyelonephritis), cause (uncomplicated vs. complicated), and recurrence (primary vs. recurrent). First-line treatments include nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin, with fluoroquinolones and cephalosporins reserved for complicated or severe cases. Non-antibiotic preventive strategies, such as cranberry products, immunostimulants, and vaginal estrogen, are recommended for recurrent UTIs to reduce antibiotic resistance.

Cranberries (Vaccinium macrocarpon) contain bioactive compounds such as A-type proanthocyanidins (PACs), anthocyanins, flavonols, phenolic acids, and terpenes like ursolic acid, which inhibit bacterial adhesion to the urinary tract. Cranberry consumption has been shown in clinical trials to reduce UTI recurrence in adult women and, to a lesser extent, in children, though results are variable depending on population, dosage, and study design.

Diagnosis relies on medical history, risk factors (sexual activity, contraception, prior antibiotics), and urine testing through dipsticks, microscopy, and bacteriological culture, with culture remaining the gold standard.

Treatment emphasizes appropriate antibiotic selection based on infection type and pathogen susceptibility. Common pathogens include E. coli, Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecalis. First-line antibiotics are effective for uncomplicated UTIs, while complicated or resistant cases may require fluoroquinolones, beta-lactams, aminoglycosides, or carbapenems. Therapy duration varies from 3–5 days for uncomplicated UTIs to 7–14 days for complicated cases. Supportive measures, including hydration and hygiene, help prevent recurrence.

References

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Copyright © 2025 Mahesh Kadam, Sarthak Kamble, Sagar Kale, Shravni Jagtap, Siddharth Jawale, Apurva Shelar. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.