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TO THE EDITOR—We applaud Dr Barbosa-Cesnik and her colleagues for their excellent contribution to the literature on cranberry juice for the prevention of urinary tract infections (UTIs) [1]. In a population of college women with recent acute UTIs, their clinical trial found no significant difference between the use of cranberry juice and placebo to prevent recurrence of infection.  Although Barbosa-Cesnik et al [1] conclude that daily use of cranberry juice did not result in a decrease in the 6-month incidence of a recurrent UTI, we favor a more conservative interpretation, since the study was underpowered to detect a difference between cranberry juice and placebo. In the Methods, the authors state that their sample size calculations were based on an anticipated UTI recurrence rate of 30%. However, the actual observed rate in the placebo arm was only 14%. Therefore, adequate power would have required enrollment of 656 participants, which we realize is a challenging task.  Other populations of women may benefit from daily cranberry juice or pills. Barbosa-Cesnik et al [1] present interesting data suggesting no benefit to cranberry juice in patients with a history of ≥2 UTIs. These findings conflict with other trials that have shown beneficial effects with cranberry juice for women with ≥2 UTIs, including a Cochrane review, which showed significant reduction in the number of recurrent UTIs with daily cranberry use in select patient populations [2]—findings that were driven by clinical trials of women who have a history of ≥3 UTIs in the past year [3–5]. Effective prevention strategies for recurrent UTIs may only work in populations of women at higher risk for recurrence.

Daily Cranberry Prophylaxis to Prevent Recurrent Urinary Tract Infections May Be Beneficial in Some Populations of Women