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சிறுநீர் பாதை தொற்றுக்களை தவிர்ப்பதற்கான கிரான்பெர்ரிகள் (சீமை களாக்காய்)

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Background

Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). This is the third update of our review first published in 1998 and updated in 2004 and 2008.

Objectives

To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations.

Search methods

We searched the Cochrane Renal Group's Specialised Register (4 June 2013) through contact with the Trials' Search Co‐ordinator using search terms relevant to this review.We contacted companies involved with the promotion and distribution of cranberry preparations and checked reference lists of review articles and relevant studies.

Date of search: July 2012

Selection criteria

All randomised controlled trials (RCTs) or quasi‐RCTs of cranberry products for the prevention of UTIs.

Data collection and analysis

Two authors independently assessed and extracted data. Information was collected on methods, participants, interventions and outcomes (incidence of symptomatic UTIs, positive culture results, side effects, adherence to therapy). Risk ratios (RR) were calculated where appropriate, otherwise a narrative synthesis was undertaken. Quality was assessed using the Cochrane risk of bias assessment tool.

Main results

This updated review includes a total of 24 studies (six cross‐over studies, 11 parallel group studies with two arms; five with three arms, and two studies with a factorial design) with a total of 4473 participants. Ten studies were included in the 2008 update, and 14 studies have been added to this update. Thirteen studies (2380 participants) evaluated cranberry juice/concentrate; nine studies (1032 participants) evaluated cranberry tablets or capsules; one study compared cranberry juice and tablets; and one study compared cranberry capsules and tablets. The comparison/control arms were placebo, no treatment, water, methenamine hippurate, antibiotics, or lactobacillus. Eleven studies were not included in the meta‐analyses because either the design was a cross‐over study and data were not reported separately for the first phase, or there was a lack of relevant data. Data included in the meta‐analyses showed that, compared with placebo, water or not treatment, cranberry products did not significantly reduce the occurrence of symptomatic UTI overall (RR 0.86, 95% CI 0.71 to 1.04) or for any the subgroups: women with recurrent UTIs (RR 0.74, 95% CI 0.42 to 1.31); older people (RR 0.75, 95% CI 0.39 to 1.44); pregnant women (RR 1.04, 95% CI 0.97 to 1.17); children with recurrent UTI (RR 0.48, 95% CI 0.19 to 1.22); cancer patients (RR 1.15 95% CI 0.75 to 1.77); or people with neuropathic bladder or spinal injury (RR 0.95, 95% CI: 0.75 to 1.20). Overall heterogeneity was moderate (I² = 55%). The effectiveness of cranberry was not significantly different to antibiotics for women (RR 1.31, 95% CI 0.85, 2.02) and children (RR 0.69 95% CI 0.32 to 1.51). There was no significant difference between gastrointestinal adverse effects from cranberry product compared to those of placebo/no treatment (RR 0.83, 95% CI 0.31 to 2.27). Many studies reported low compliance and high withdrawal/dropout problems which they attributed to palatability/acceptability of the products, primarily the cranberry juice. Most studies of other cranberry products (tablets and capsules) did not report how much of the 'active' ingredient the product contained, and therefore the products may not have had enough potency to be effective.

Authors' conclusions

Prior to the current update it appeared there was some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period, particularly for women with recurrent UTIs. The addition of 14 further studies suggests that cranberry juice is less effective than previously indicated. Although some of small studies demonstrated a small benefit for women with recurrent UTIs, there were no statistically significant differences when the results of a much larger study were included. Cranberry products were not significantly different to antibiotics for preventing UTIs in three small studies. Given the large number of dropouts/withdrawals from studies (mainly attributed to the acceptability of consuming cranberry products particularly juice, over long periods), and the evidence that the benefit for preventing UTI is small, cranberry juice cannot currently be recommended for the prevention of UTIs. Other preparations (such as powders) need to be quantified using standardised methods to ensure the potency, and contain enough of the 'active' ingredient, before being evaluated in clinical studies or recommended for use.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

சிறுநீர் பாதை தொற்றுக்களை தவிர்ப்பதற்கான கிரான்பெர்ரிகள்

சிறுநீர் பாதை தொற்றுக்களை தவிர்ப்பதற்கு கிரான்பெர்ரிகள் (கிரான்பெர்ரி சாறாக) பயன்படுத்தப்பட்டு வருகிறது. சிறுநீர் பையின் சுவர்களில் பாக்டீரியாவை ஒட்டாமல் தடுக்கக் கூடிய ஒரு வஸ்தை கிரான்பெர்ரிகள் கொண்டுள்ளன. இது, சிறுநீர் பை மற்றும் பிற தொற்றுக்களை தடுக்கக் கூடும். கிரான்பெர்ரி தயாரிப்புகளை ஒரு கட்டுப்பாடு அல்லது மாற்று சிகிச்சைகளோடு ஒப்பிட்ட 24 ஆய்வுகளை (4473 பங்கேற்பாளர்கள்) இந்த திறனாய்வு அடையாளம் கண்டது. கட்டுப்பாடு அல்லது மாற்று சிகிச்சையோடு ஒப்பிடும் போது, கிரான்பெர்ரி தயாரிப்பை உட்கொண்ட மக்களில் குறைவான தொற்றுக்களை நோக்கிய போக்கு இருந்தது, ஆனால் இது ஒரு குறிப்பிடத் தகுந்த கண்டுபிடிப்பாக இல்லை. ஒரு ஏற்கத்தகுந்த சிகிச்சை தலையீடாக இல்லாதபடிக்கு, இந்த ஆய்வுகளில், அநேக மக்கள் கிரான்பெர்ரி சாறு பருகுவதை நிறுத்தி விட்டனர். சிறுநீர் பாதை தொற்றுக்களை தவிர்ப்பதில் கிரான்பெர்ரி சாறு ஒரு குறிப்பிடத்தகுந்த நன்மையை கொண்டிருப்பதாக தெரியவில்லை மற்றும் நீண்ட‐காலத்திற்கு அதை உட்கொள்ளுவதற்கு ஏற்புடையதாக இருக்காது. ஒரு செயலாற்றல் உள்ள உட்பொருள் இல்லாத பட்சத்தினால், கிரான்பெர்ரி தயாரிப்புகள் (மாத்திரைகள் மற்றும் காப்ஸ்யூல் போன்ற) திறன்மிக்கதாக இருக்கவில்லை (ஆன்டிபையாட்டிஸ் எடுத்துக்கொள்வதை போன்ற விளைவை கொண்டிருந்தாலும்).