Comparative Evaluation of Three Cranberry Formulations in Women with Recurrent Urinary Tract Infections: An Observational Study.

PURPOSE: Although cranberry supplementation has been investigated for recurrent UTI prevention with heterogeneous demonstrations, direct comparisons of putative active compositions remain scarce. The present study aimed to compare three cranberry formulations differing in composition and PACs (Proanthocyanidins) profiles on recurrent UTI episodes, urinary symptoms and quality of life in women with recurrent UTIs. PATIENTS AND METHODS: Three extracts differing in the sources of their fruits, extraction process, solubility, and composition were characterized (40SD, 40G, and FG). A total of 219 women aged 18 to 65 years with recurrent UTI episodes were enrolled in an observational, comparative, open-label, parallel clinical study and allocated to receive one of three treatments for 6 months. Posology was standardized to provide equivalent amounts of PACs, and endpoints were assessed at baseline and after 6 months. RESULTS: Extract characterization differed notably for organic acids, fibre, monomeric phenolic compounds, soluble and oligomeric forms of PACs, and the degree of polymerization. All three extracts significantly improved urinary comfort (VAS, 53.8 ± 16.2 → 80.9 ± 25.6; p < 0.001), symptomatic episodes (frequency: 2.9 → 0.8; p < 0.001; duration: 2.7 → 0.7 days; p < 0.001), global symptom intensity assessed using the ACSS, global quality of life assessed using the SF-Qualiveen, and psychosocial impact questionnaire scores, with no significant differences between groups. However, the 40G group showed a significantly greater improvement in ACSS-Differential scores (symptoms related to adjacent organs) during cystitis-like episodes, complementary ACSS items (eg, burden on daily activities), the "Fears" domain of SF-Qualiveen, and earlier onset of significant effects in these questionnaires. CONCLUSION: The standardization of posology based on total PACs (162 mg/day, including insoluble polymeric forms) rather than soluble oligomeric PACs (36 mg/day, BL-DMAC) appears relevant for the improvement of UTIs and related symptoms. Treatment with an extract (40G) with a specific ratio of insoluble/soluble fruit parts and, consequently, a distinct PACs profile resulted in greater improvements. TRIAL REGISTRATION: NCT04962971.