A simple sugar that leaves the body in the urine, where it can loosen the grip of bacteria behind most bladder infections. Cheap and well tolerated; loose stools and bloating are common complaints. Studies where people knew what they took show fewer repeat infections; studies where no one knew show none. Uses beyond the bladder rest on animal work. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Culture-confirmed infections per 6 months | 0 to 1 | The only endpoint the trials actually measured |
| Urine culture organism and colony count | Under 10³ CFU/mL when asymptomatic | Confirms the organism is mannose-binding Escherichia coli |
| Urinalysis nitrite and leukocyte esterase | Both negative | Fast screen distinguishing infection from irritation |
| Fasting glucose | 75 to 90 mg/dL | Detects any glycemic drift on high doses |
| HbA1c | 4.8 to 5.4% | Three-month average blood sugar, unaffected by a single dose |
| eGFR | Above 90 mL/min/1.73 m² | Governs both systemic exposure and urinary delivery |
Cadence: Infection count at three months and again at six months; urine culture at each new symptomatic episode rather than on a schedule; glucose markers at three months only if the baseline was abnormal; kidney function every six to twelve months in those who had a reason to measure it initially.