Prevención no antibiótica de la cistitis recurrente: D-manosa, arándano, probióticos y estrógenos tópicos. Revisión sistemática

The objective was to analyze the efficacy of D-mannose, cranberry, probiotics and topical estrogens in the non-antibiotic prevention of recurrent cystitis in women. A systematic review was conducted according to the PRISMA 2020 statement, searching PubMed, the Cochrane Library and SciELO for randomized clinical trials, systematic reviews and meta-analyses published between 1993 and 2025; 13 studies were included. Cranberry reduced the risk of recurrence in women with recurrent urinary tract infections (RR 0.74). Vaginal estrogens decreased recurrences in postmenopausal women (RR 0.42), unlike the oral route. D-mannose showed benefit in small trials, but the largest placebo-controlled trial did not confirm its efficacy. Probiotics did not demonstrate a consistent effect. It is concluded that vaginal estrogens and cranberry have the strongest support, while D-mannose and probiotics require trials of higher methodological quality.