Nutraceutical Efficacy for rUTI
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|ClinicalTrials.gov Identifier: NCT03395288|
Recruitment Status : Recruiting
First Posted : January 10, 2018
Last Update Posted : June 22, 2020
|Condition or disease||Intervention/treatment||Phase|
|Urinary Tract Infections||Drug: D-Mannose||Phase 2 Phase 3|
The objective of this study is to determine the efficacy of a nutraceutical as a non-antibiotic prophylaxis for postmenopausal women on vaginal estrogen therapy (VET) with a history of symptomatic, culture-proven recurrent urinary tract infection (rUTI) by means of a randomized, controlled trial. Recurrent urinary tract infections have a significant impact on patient health, quality of life, and finances (personal and societal).
The most common uropathogen for both acute and recurrent UTIs is Escherichia coli.
Historically, patients with rUTI have been placed on long-term prophylactic antibiotics to prevent recurrence. Long term antibiotic use can lead to antibiotic resistance, collateral damage to normal flora, and organ damage, such as pulmonary and hepatic toxicity with long-term nitrofurantoin use. There is an increasing prevalence of antibiotic resistance of uropathogenic E. coli and other uropathogens. Antibiotic resistance and its consequences have resulted in a need for non-antibiotic prophylaxis regimens.
A growing body of literature supports the use of vaginal estrogen therapy as a first-line non-antibiotic UTI prevention strategy in postmenopausal women. While VET has been shown to significantly reduce the risk of rUTIs, some women continue to have rUTIs. Other non-antibiotic strategies have been utilized including D-mannose, a nutraceutical. Three prior studies examined D-mannose as an isolated therapy with promising results, but in our experience, a multimodal approach has often been needed. Therefore, additional studies, such as this proposed research, are needed to determine the potential additive effect of a nutraceutical as a non-antibiotic prophylaxis for postmenopausal women using vaginal estrogen therapy.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||180 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||There will be a RCT portion of the study with a treatment arm and a control arm and an additional observational arm of the study.|
|Masking Description:||Participants in the RCT treatment and RCT control arm will not be told the name of the nutraceutical being studied. Participants in the observational arm will be aware of the nutraceutical being studied.|
|Official Title:||Randomized, Controlled Trial to Determine the Efficacy of Nutraceutical vs Control as Non-antibiotic Prophylaxis for Recurrent Urinary Tract Infection in Postmenopausal Women Using Vaginal Estrogen Therapy|
|Actual Study Start Date :||March 22, 2018|
|Estimated Primary Completion Date :||December 2021|
|Estimated Study Completion Date :||December 2021|
Experimental: RCT treatment arm
Participants in this arm will dissolve one (1) level teaspoon of the nutraceutical powder (D-mannose) in at least 200 ml of water one time a day, approximately every 24 hours. (200 ml of water = 6.7 fluid ounces). Duration of study drug is 90 days.
A total of 2 g D-mannose daily
No Intervention: RCT control arm
Participants in this arm will not use any additional intervention.
Experimental: Observational arm
Participants in this arm will either take a total of 1000 mg D-mannose in capsule form every 12 hours OR they will dissolve one (1) level teaspoon of the nutraceutical powder (D-mannose) in at least 200 ml of water one time a day, approximately every 24 hours. (200 ml of water = 6.7 fluid ounces). Duration of study drug is 90 days. Participants in this arm of the study have different home medications prior to study enrollment than participants in the RCT treatment arm.
A total of 2 g D-mannose daily
- incidence of symptomatic, culture proven urinary tract infections [ Time Frame: each participant will be followed for 90 days during study enrollment ]To compare the cumulative incidence of symptomatic, culture-proven urinary tract infections in postmenopausal women with a history of rUTI on vaginal estrogen therapy randomized to receive prophylactic D-mannose versus women using vaginal estrogen therapy alone (control).
- incidence of symptomatic culture proved UTI from D-mannose susceptible uropathogens [ Time Frame: each participant will be followed for 90 days during study enrollment ]To compare the incidence of symptomatic, culture-proven urinary tract infections caused by all uropathogens potentially susceptible to D-mannose therapy in women receiving D-mannose and the control group. We will also compare these findings to the incidence of symptomatic, culture-proven urinary tract infections caused by uropathogens susceptible to D-mannose therapy in the absence of vaginal estrogen therapy (observational arm).
- side effects [ Time Frame: each participant will be followed for 90 days during study enrollment ]To describe the side effects of D-mannose and determine the incidence of discontinuation of therapy due to side effects.
- incidence of symptomatic, culture proven UTI in all participants taking D-mannose [ Time Frame: each participant will be followed for 90 days during study enrollment ]To compare the cumulative incidence of symptomatic, culture-proven urinary tract infections between women receiving prophylactic D-mannose treatment alongside vaginal estrogen therapy verses women receiving prophylactic D-mannose treatment whom are not on vaginal estrogen therapy (observational arm).
- design of future studies [ Time Frame: exit survey at completion of each participant's 90 days of enrollment in the study ]To gain information to use in designing future rUTI studies
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03395288
|Contact: Jerry Lowderemail@example.com|
|Contact: Stephanie Russellfirstname.lastname@example.org|
|United States, Missouri|
|Washington University School of Medicine||Recruiting|
|Saint Louis, Missouri, United States, 63110|
|Contact: administrative assistant 314-747-1402|
|Principal Investigator:||Jerry Lowder, MD||Washington University School of Medicine|