Background: Recurrent urinary tract infections (UTIs) are a common clinical problem among premenopausal women, often managed with prophylactic antibiotics that contribute to antimicrobial resistance. Cranberry extract, rich in proanthocyanidins, has emerged as a promising non-antibiotic alternative for UTI prevention, though existing evidence remains inconsistent due to variability in study designs and formulations. 

Objective: To evaluate the effectiveness of standardized cranberry extract supplementation in reducing recurrence rates of urinary tract infections in premenopausal women. 

Methods: This double-blind, randomized controlled trial was conducted over ten months in tertiary care hospitals in Lahore, Pakistan. A total of 160 premenopausal women with a history of recurrent UTIs were enrolled and randomly assigned to receive either 500 mg cranberry extract standardized to 36 mg PACs or placebo once daily for six months. Primary outcomes included the mean number of recurrent UTI episodes and time to first recurrence. Secondary outcomes assessed antibiotic use, adherence, and patient satisfaction. Data were analyzed using independent t-tests, Kaplan-Meier survival analysis, and chi-square tests, with significance set at p<0.05. 

Results: The cranberry group reported a significantly lower mean number of UTI episodes (0.6 vs. 1.2), longer time to first recurrence (142.3 vs. 97.6 days), and reduced antibiotic use (0.7 vs. 1.4 courses) compared to placebo. Recurrence occurred in 27.5% of the cranberry group versus 57.5% in placebo. Adherence exceeded 90% in both groups, with higher satisfaction in the cranberry arm. No serious adverse events were reported. Conclusion: Cranberry extract supplementation effectively reduced UTI recurrence and antibiotic dependence among premenopausal women. These findings support its role as a safe, non-antibiotic preventive strategy.