Probiotics in Preventing Recurrent UTIs in Women

Abstract and Introduction

Abstract

Increasing antibiotic resistance and increasing resistance to commonly used antibiotics makes treatment and prevention of urinary tract infections difficult. Although more research is needed, probiotics should be considered a useful and safe alternative to antibiotics.

Introduction

Urinary tract infections (UTIs) are one of the most common bacterial infections in women, accounting for over 6 million primary care visits annually (Zak, 2014). Approximately 50% to 60% of women will develop a UTI in their lifetime (Al-Badr & Al-Shaikh, 2013), and one-third of women will experience at least one UTI by age 26 (Giesen, Cousins, Dimitrov, van de Laar, & Fahey, 2010).

Treatment is often complicated by the high rates of reoccurrence. Approximately 20% to 30% of women with a UTI will have a reoccurrence (Beerepoot, Geerlings, van Haarst, van Charante, & ter Riet, 2013); 10% to 20% of women with a UTI will experience another within a few months, and 27% within six to 12 months (Fihn, 2003; Franco, 2005; Zak, 2014). Ikaheimo et al. (1996) found that in the primary care setting, 53% of women over 55 years of age and 36% of younger women will have a reoccurrence within a year. Women are diagnosed with recurrent UTIs if they have three UTIs with three positive urine cultures within a 12-month period or two infections in the previous six months (Al-Badr & Al-Shaikh, 2013).

Symptoms of UTIs include dysuria, frequency, urgency, nocturia, suprapubic pain, and hematuria, all of which significantly affect the quality of life. Contributing factors to UTIs include inadequate hydration, voiding patterns, diaphragm and spermicide use, tight undergarments, wiping technique, immuno-suppression, postmeno pausal women, diabetes mellitus, and frequent sexual intercourse (Al-Badr & Al-Shaikh, 2013). Escheria coli (E. coli) causes the majority of UTIs in women, accounting for 75% to 95% of infections (Al-Badyr & Al-Shaikh, 2013; Nosseir, Lind, & Winkler, 2012). Recurrent UTIs are most often (~80% of time) caused by reinfection with the same pathogen (Al-Badyr & Al-Shaikh, 2013; Nosseir et al., 2012).

Continuous antibiotics are currently used as treatment and prophylaxis for recurrent UTIs. The literature recommends treating anywhere from 6 to 12 months to 2 to 5 years (Zak, 2014). However, the long-term effects of antibiotics are unknown. We are currently in an age of increasing antibiotic resistance, and increasing resistance to commonly used antibiotics, such as trimethoprim-sulfamethoxazole (Gupta, Hooton, & Stamm, 2001), makes treatment and prevention of infections difficult. Therefore, finding safe and effective alternatives to preventing recurrent UTIs in women is imperative. This article will examine the evidence on the role of probiotics in preventing recurrent UTIs in women.

Table 1. Evidence on the Efficacy of Probiotics in Preventing Recurrent Urinary Tract Infections
Author(s) (Year)	Sample (N)	Type of Intervention; Outcome Measures	Findings and Conclusions	Quality and Level of Evidence (GRADE)
Abdulwahab, Abdulazim, Nada, & Radi (2013)	200 (100 healthy women and isolates from 100 women with recurrent UTIs)	Culture of vaginal swabs of asymptomatic women to identify Lactobacilli and culture of urine of women with recurrent infections; inhibitory effect of Lactobacilli isolates on uropathogenic E. coli.	All vaginal Lactobacilli strains from asymptomatic women could inhibit the growth of E. coli on the agar plate.	Moderate, Level 2
Beereproot et al. (2012)	252	12 months prophylaxis with TMP-SMX 480 mg once daily or 109 CFU L. rhamunosus or L. reuteri twice daily; mean number of symptomatic UTIs, time to first UTI, development antibiotic resistance, proportion 1+ UTI in 12 months.	After 12 months of prophylaxis, the mean number of symptomatic UTIs decreased in women taking Lactobacillus. Lactobacillus not found noninferior to TMP-SMX, although advantages included no antibiotic resistance and improved efficacy in preventing complicated UTIs.	Moderate, Level 2
Stapleton et al. (2011)	100	Intravaginal lactin-V probiotic or placebo five days, then once per week for 10 weeks; number of UTIs and level of colonization by L. crispatus.	L. crispatus was associated with reduced symptomatic UTIs.	Low, Level 2

Table 1. Evidence on the Efficacy of Probiotics in Preventing Recurrent Urinary Tract Infections

Author(s) (Year)

Sample (N)

Type of Intervention; Outcome Measures

Findings and Conclusions

Quality and Level of Evidence (GRADE)

Abdulwahab, Abdulazim, Nada, & Radi (2013)

200 (100 healthy women and isolates from 100 women with recurrent UTIs)

Culture of vaginal swabs of asymptomatic women to identify Lactobacilli and culture of urine of women with recurrent infections; inhibitory effect of Lactobacilli isolates on uropathogenic E. coli.

All vaginal Lactobacilli strains from asymptomatic women could inhibit the growth of E. coli on the agar plate.

Moderate, Level 2

Beereproot et al. (2012)

252

12 months prophylaxis with TMP-SMX 480 mg once daily or 109 CFU L. rhamunosus or L. reuteri twice daily; mean number of symptomatic UTIs, time to first UTI, development antibiotic resistance, proportion 1+ UTI in 12 months.

After 12 months of prophylaxis, the mean number of symptomatic UTIs decreased in women taking Lactobacillus. Lactobacillus not found noninferior to TMP-SMX, although advantages included no antibiotic resistance and improved efficacy in preventing complicated UTIs.

Moderate, Level 2

Stapleton et al. (2011)

100

Intravaginal lactin-V probiotic or placebo five days, then once per week for 10 weeks; number of UTIs and level of colonization by L. crispatus.

L. crispatus was associated with reduced symptomatic UTIs.

Low, Level 2