Traditionally, cranberry has been u...

Traditionally, cranberry has been used for the treatment and prophylaxis of urinary tract infections. Research glance ats that its mechanism of action is preventing bacterial adherence to landlord cell surface membranes. Systematic reviews have conclud that no reliable evidence supports the use of cranberry in the treatment or prophylaxis of urinary tract infections; however, more new randomized controlled trials demonstrate evidence of cranberry's utility in urinary tract infection prophylaxis. Supporting studies in humans are lacking for other clinical uses of cranberry. Cranberry is a safe, well-tolerated herbal complement that does not have significant mix with drugs inter-actions. (Am Fam Physician 2004;70:2175-77 Copyright[C] 2004 American Academy of Family Physicians.)

American cranberry Vaccinium macrocarpon) is single in kind of only three of fruit native to North America. The other species are Vaccinium angustifolia) and bilberry (Vaccinium myrtillus). Cranberry typically shoots in bogs and is a member of the same family as blueberry and bilberry. Massachusetts and Wisconsin are the main areas of present-day commercial production of cranberry. (1) The ripe fruit was used medicinally according to Native Americans for the treatment of bladder and kidney ailments. Pilgrims called the fruit "craneberry" because the stipe and flower resembled the head, neck and beak of a crane. (1) Therapeutic applications of cranberries documented during the 17th centenary included the relief of descendants disorders, stomach ailments, liver riddles vomiting, appetite loss, scurvy, and cancer. (2) Before the advent of antibiotics, cranberry continued to be a popular treatment for urinary tract infections (UTIs). (3)

Pharmacology

The mechanism of action of cranberry has quicked much scientific discussion. It was first hypothesized that acidification of the urine contributed to an antibacterial issue The current proposed mechanism of action focuses primarily in succession cranberry's ability to prevent bacterial binding to legion cell surface membranes. In vitro studies have observ strong inhibition of bacterial adherence of Escherichia coli (4) and other gram-negative uropathogens. (5) Cranberry has been construct to specifically inhibit hemagglutination of E coli by the agency of expression of types 1 and P adhesin (6) by the and of the component compounds fructose (7) and proanthocyanidins. (8)

Uses and Efficacy

URINARY TRACT INFECTION

In the United States, the same of every five women has been reported to have a lifetime incidence of UTI. (9) Of these women 3 percent experience renewed disease. (9) Eleven million women receive medication for UTIs annually. (10) A late Cochrane Database systematic review (11) ground no randomized trials assessing the effectiveness of cranberry juice in the treatment of UTIs and conclud that there is no evidence to support its use. There is a great deal greater evidence-based information available for the use of cranberry in UTI prophylaxis.

The first relatively large placebo-controlled studies (1213) assessing efficacy were directioned in elderly women living in long-term care facilities. The findings of these studies (1213) showed that cranberry significantly reduc the common occurrence of bacteriuria and pyuria, on the other hand these were not intention-to-treat analyses. A 1997 reflection published as a letter in The Journal of Family Practice, (14) used a younger cohort of women and was the first thought to use cranberry extract tablets rather than juice. conclusions showed that the cranberry concentrate was more effective than placebo in reducing the event of UTIs. (14) However, and nothing else 10 women completed the consideration (14) Another pair of studies (1516) institute cranberry ineffective in decreasing bacteriuria in children with neurogenic bladder requiring intermittent catheterization. A Cochrane Database systematic review, (17) citing small sample sizes and the poor quality of available trials, determined that there was no reliable evidence of effectiveness of cranberry in UTI prophylaxis.

However, since 2001 couple good-quality studies have been published. The first trial (18) of 150 women consisted of three arms: (1) cranberry/lingonberry juice; (2) probiotic-supplementation with Lactobacillus GG drink; and (3) no intervention for 12 month Findings were a statistically significant 20 percent reduction in absolute risk of infection in women receiving cranberry (number destitutioned to treat: 5) compared with no event in the probiotic-supplementation and no-intervention arranges (18) Most recently, a randomized, placebo-controlled trial (19) of 150 women through a 12-month period found that cranberry juice and cranberry extract tablets significantly decreased the number of patients having at least common symptomatic UTI per year.

OTHER USES

A single experimental consideration (20) showed that the "high-molecular-weight constituent" of cranberry juice that inhibits the adherence of E coli was effective in reversing and inhibiting the coaggregation of a large portion of dental plaque bacteria. Cranberry also has been commended as an adjunctive treatment for Candida infections. In vitro stud-have shown that cranberry juice put in actions fungistatic effects against dermatophytic and other fungi on the other hand has no effect against Candida albicans. There are no controll trials in humans evaluating the effectiveness of cranberry in treating fungal infections.