Probiotics prophylaxis for recurrent urinary tract infections

What is it about?

INTRODUCTION & OBJECTIVES: Recurrent urinary tract infections (UTIs) afflict a great number of women around the world. The growth of antibiotic resistance necessitates the study of nonantibiotic prevention of recurrent UTIs. The aim of this study was to compare prophylaxis with ciprofloxacin and oral lactobacilli (L. rhamnosus GR-1and L. reuteri RC-14) in premenopausal women with recurrent UTIs. MATERIAL & METHODS: Open, randomized controlled 12 month follow up trial. 85 women with uncomplicated recurrent UTIs, caused by E. coli or S. faecalis, were randomly allocated into two groups: ciprofloxacin, 125 mg, once daily, 5 days per week or oral capsules containing 109 colony-forming units (cfu/ml) of L. rhamnosus GR-1 and L. reuteri RC-14 twice daily, 2 weeks of every month. In Ukraine resistance levels of E. coli and S. faecalis to trimethoprim-sulfamethoxazole makes 36% and 84% respectively. Therefore, to prevent recurrent UTIs we used ciprofloxacin. Results were assessed by the mean number of recurrences UTIs, defined as bacterial growth ≥105 cfu/ml in a clean midstream urine. For statistical analysis we used the t-test and for independent samples and difference tests (%) – Statistica 10.0 for Windows. The effect of the intervention was described using odds ratio (OR) and 95% confidence intervals (CI). RESULTS: The mean number of recurrence UTIs in the year preceding randomization was 7.1±2.5 in the ciprofloxacin group and 6.3±4.2 in the lactobacilli group (p=0.35). After 12 months of prophylaxis, these numbers were 1.8±0.7 and 2.7±1.38, respectively (p=0.19). Five of women who received ciprofloxacin had at least one UTI during 12 month, compared to seven in the lactobacilli group (11% vs 17.5%, p=0.4). Compared with ciprofloxacin group, lactobacilli showed the same efficacy of a preventive therapy (OR 1.7, 95% CI 0.5 to 5.8). But the median times to the first UTIs were 8.2±1.5 and 3.8±1.7 months for the ciprofloxacin and lactobacilli groups, respectively (p<0.001). CONCLUSIONS: The results suggest that oral Lactobacillus (L. rhamnosus GR-1 and L. reuteri RC-14) in their efficiency are not inferior to ciprofloxacin and may be used to prevent uncomplicated recurrent UTIs in premenopausal women

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