Cranberry dosed extract: an effective therapy for recurrent Escherichia coli cystitis in elderly patients. The GerHogar Cysticlean® study

  • Juan F. Macías-Núñez FIIPERVA chair. University Salamanca, Spain
  • Carmen Pablos-Hernandez University Hospital of Salamanca
  • Jesús J Cuadrado-Blanco Medical Director and Urinary Incontinence Department. Salamanca
  • Guzman Tamame-Gonzalez Residencia de Personas Mayores “Los Tres Árboles” de la Junta de Castilla y León. Zamora, Spain. Centro de Día “Ciudad Jardín” de la Asociación de Familiares de Alzheimer. Zamora
  • Agapito Gomez- Villa Centro de Salud "Zona Centro", Cáceres
  • Amparo del Cañizo-Alvarez Centro de Salud Sancti Spiritus-Canalejas, Salamanca
  • Carlos Guido Musso Universidad de Buenos Aires, Hospital Italiano, Argentina
Palabras clave: arándano, cistitis, infección urinaria.


Introduction: Cystitis is the most prevalent urinary tract infection (UTI), and antibiotics are its conventional therapy. However, the prevalence rate of antibiotic resistance to uropathogens is significantly increased. Cranberry treatment has been associated with the inhibition of Escherichia coli (Ec) adherence to uroepithelial cells due to the anti-adhesive property related to its proanthocyanidins content, and cysticlean® (CYS) is a cranberry extract which contains 240 mg PACs per capsule. Since elderly people is one of the populations mostly exposed to cystitis and bacteria antibiotic resistance, it was decided to originally study the efficacy and safety of CYS, to treat cystitis instead of antibiotic, in elderly individuals.

Material & Methods: Two groups were studied: Group 1 (G1): first cystitis episode was recorded within the last 3 months before the study initiation. Group 2 (G2): frequent cystitis recurrent episodes (1-2/month or more) within the last 3 months before the study initiation. G1 patients were treated with 1 capsule of CYS every 12 h for 1 month, while G2 patients were treated up to 12 months. Comparative evaluation was performed using Student test.

Results: 160 elderly ambulatory and nursing home patients suffering from recurrent cystitis were treated with CYS. G1 and G2 had 38 and 122 subjects, respectively. Cranberry-based cystitis treatment was successful in 81.57% and 81.96% in G1 and G2 patients, respectively.

Conclusion: CYS showed to be an effective alternative therapy to antibiotics to treat cystitis recurrences caused by Ec. Neither side effects nor adverse reactions have been reported.


La descarga de datos todavía no está disponible.


Tandogdu Z, Wagenlehner FM. Global epidemiology of urinary tract infections. Current Opinion in InfectiousDiseases. 2016; 29(1):73-79. DOI:10.1097/QCO.0000000000000228

Flores-Mireles AL, Walker JN, Caparon M, Hultgren.JS. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015 May; 13(5): 269–284., April 5, 2018.

Lee C, Ventola P T. The Antibiotic Resistance Crisis. Part 1: Causes and Threats.. 2015 Apr; 40(4): 277–283

Blair JMA, Webber MA, Baylay AJ, Ogbolu DO, Piddock LJV. Molecular mechanisms of antibiotic resistance. Nature Reviews Microbiology.2015;13:42-51. doi:10.1038/nrmicro3380

Van Puyvelde S, Deborggraeve S, Jacobs J. Why the antibiotic resistance crisis requires a One Health Approach. The Lancet. 2018;18(2):132–134

Finkelstein R, Kassis E, Reinhertz G, Gorenstein S, Herman P. Community-acquired urinary tract infection in adults: a hospital viewpoint.. J Hosp Infect. 1998 Mar;38(3):193-202.

Beerepoot MAJ, Riet G, Nys S, van der Wal WM, de Borgie CAJM, de Reijke TM, Prins JM, Koeijers J, Verbon A, Stobberingh E, Geerlings SE. Cranberries vs Antibiotics to Prevent Urinary Tract Infections: A Randomized Double-blind Noninferiority Trial in Premenopausal Women.. Arch. Intern. Med. 2011;171(14).

McMurdo ME, Argo I, Phillips G, Daly F, Davey P. Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. J Antimicrob Chemother. 2009 Feb;63(2):389-95. doi: 10.1093/jac/dkn489.

Uberos J, Nogueras-Ocana M, Fernández-Puentes V, Rodríguez-Belmonte R, Narbona-López E, Molina-Carballo A, Muñoz-Hoyos A.Cranberry syrup vs trimethoprim in the prophylaxis of recurrent urinary tract infections among children: a controlled trial. Open Access Journal of Clinical Trials 2012:4 31–38

Caljouw MAA, van den Hout WB, Putter H, Achterberg WP, Cools HJM, Gussekloo J. Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infections in Vulnerable Older Persons: A Double-Blind Randomized Placebo-Controlled Trial in Long-Term Care Facilities. JAGS 62:103–110, 2014.

Beerepoot M, Geerlings S. Non-Antibiotic Prophylaxis for Urinary Tract Infections. Pathogens. 2016; 5:36 doi:10.3390/pathogens5020036.

Hisano M, Bruschini H, Nicodemo AC, Srougi M. Cranberries and lower urinary tract infection prevention. Clinics (Sao Paulo). 2012 Jun; 67(6): 661–667. doi: 10.6061/clinics/2012(06)18.

Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews.2012;10: CD001321.

Nicolle LE. Cranberry for Prevention of Urinary Tract Infection? Time to Move On. JAMA. 2016;316(18):1873-1874. doi:10.1001/jama.2016.16140.

Mayor S. Cranberry capsules do not reduce urinary tract infections in older women, study finds. BMJ 2016; 355 doi:

Singh I, Gautam LK, Kaur IR. Effect of oral cranberry extract (standardized proanthocyanidin-A) in patients with recurrent UTI by pathogenic E. coli: a randomized placebo-controlled clinical research study.Int Urol Nephrol. 2016 Sep;48(9):1379-86. doi: 10.1007/s11255-016-1342-8.

Vostálová J, Vidlar A, Simánek V, Student V. Are High Proanthocyanidins Key to Cranberry Efficacy in the Prevention of Recurrent Urinary Tract Infections?.Phytotherapy Research 29(10) · August 2015 with 614 Reads. DOI: 10.1002/ptr.5427.

Howell AB, Botto H, Combescure C, Blanc-Potard AB, Gausa L, Matsumoto T, Tenke P, Sotto A, Lavigne JP. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis. 2010; 10: 94. 10.1186/1471-2334-10-94.

Concentration-Dependent Effect On Adherence Of Escherichia Coli To Bladder Epithelial Cells Of Cysticlean Capsules (240 Mg/Capsule Of Proanthocyanidins).. The Internet Journal of Microbiology Volume 13 Number 1 DOI: 10.5580/IJMB.33094.

Howell AB, Botto H, Combescure C, Blanc-Potard AB, Gausa L, Matsumoto T, Tenke P, Sotto A, Lavigne JP Dosage effect on uropathogenic Escherichia coli antiadhesion activity in urine followingconsu ption of cranberry powder standardized for proanthocyanidin content:a multicentricrandomized double blind study. BMC Infect Dis. 2010 Apr 14;10:94. doi: 10.1186/1471-2334-10-94.

Risco Rodríguez E, Suárez H, Bonet I, Cuadrado Blanco JJ. Evaluation Of Cysticlean® Capsules, A Cranberry Extract With High Anti-Adhesion Activity, As Monotherapy In Uncomplicated Cystitis: An Observational Pilot Study. Rev Electron Biomed / Electron J Biomed 2015;2:19-28.

Garat J.M. Treatment/prevention of urinary infections in children using cranberries. Urol Integr Invest 2009:14(2).

Bonet I, Batista E, Conejero J, Cortadellas L, Mandaña A, Peyrí E, Pigrau A, Urmeneta JM. Vargas C, Viladoms JM. Cranberries in the treatment of cystitis. Urol Integr Invest 2008;13(3):214-217.

Collado A, Trassierra M, Monllor E, Navalón R, Tramoyeres A, Ordoño F, Osca J, Gómez A,. Monzonís L, Dumont R. Observational study of using American cranberry extract rich in proanthocyanidins to treat recurrent urinary tract infections. Urol Integr Invest 2009;14(4):366-369.

Garat Barredo JM. Treatment of paediatric urinary infections with American cranberry extract. Acta Pediátrica Española. 2011; 69(3): 117-120.

Musso CG, de Los Rios E, Vilas M, Terrasa S, Bratti G, Varela F, Diez GR, Jauregui J, Luna D.The HUGE formula (hematocrit, urea, gender) for screening for chronic kidney disease in elderly patients: a study of diagnostic accuracy.Int Urol Nephrol. 2017 Apr;49(4):677-680. doi: 10.1007/s11255-016-1486-6.

Musso CG, Álvarez-Gregori J, Jauregui J, Macías-Núñez JF. Glomerular filtration rate equations: a comprehensive review.Int Urol Nephrol. 2016 Jul;48(7):1105-10. doi: 10.1007/s11255-016-1276-1.

Sánchez Ballester F, Ruiz Vidal V, López Alcina E, Doménech Perez C, Escudero Fontano E, Oltra AM, Benavent, Montoliu García A, Sobrón Bustamante MA. Cysticlean® a highly PAC standardized content in the prevention of recurrent urinary tract infections: an observational, prospective cohort study.BMC Urology 2013, 13; 28 doi: 10.1186/1471-2490-13-28.

Altarac S, Papeš D. Use of D-mannose in prophylaxis of recurrent urinary tract infections (UTIs) in women. BJU Int. 2014 Jan;113(1):9-10. doi: 10.1111/bju.12492.

Cómo citar
Macías-Núñez JF, Pablos-Hernandez C, Cuadrado-Blanco JJ, Tamame-Gonzalez G, Gomez- Villa A, del Cañizo-Alvarez A, Musso CG. Cranberry dosed extract: an effective therapy for recurrent Escherichia coli cystitis in elderly patients. The GerHogar Cysticlean® study. Rev. Colomb. Nefrol. [Internet]. 26 de enero de 2021 [citado 18 de abril de 2021];8(1):137-54. Disponible en:
Artículo de investigación original