Increasing Prevalence of Antimicrobial Resistance Among Uropathogens—Reply

In Reply: As pointed out by Drs Daniels and Zaman, cranberry juice contains compounds that competitively inhibit the attachment of E coli to uroepithelial cells.¹ In addition, the ingestion of cranberry juice decreased the incidence of asymptomatic bacteriuria and pyuria in a group of elderly institutionalized women.² However, the incidence of symptomatic urinary tract infections (UTIs) in this study was not significantly different in the cranberry juice vs placebo groups. In another study, Walker and colleagues³ demonstrated a possible reduction in symptomatic UTIs in young women who ingested a solid cranberry extract product for 3 months. In both of these studies, standard antimicrobial agents were used for treatment of symptomatic UTIs occurring during the study period. To our knowledge, there have been no large controlled trials confirming the preventative effects of cranberry juice on symptomatic UTIs in women. Thus, further investigations are needed prior to endorsing cranberry juice for use in general practice. More important, cranberry juice has not been studied as a treatment for symptomatic UTI, and we would recommend antimicrobials instead of cranberry juice for this circumstance.