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Meta-Analysis
. 2015 Dec 23;2015(12):CD008772.
doi: 10.1002/14651858.CD008772.pub2.

Probiotics for preventing urinary tract infections in adults and children

Erin M Schwenger  1 , Aaron M Tejani, Peter S Loewen
Affiliations
Meta-Analysis

Probiotics for preventing urinary tract infections in adults and children

Erin M Schwenger et al. Cochrane Database Syst Rev. .

Abstract

Background: Urinary tract infection (UTI) is a common bacterial infection that can lead to significant morbidity including stricture, abscess formation, fistula, bacteraemia, sepsis, pyelonephritis and kidney dysfunction. Mortality rates are reported to be as high as 1% in men and 3% in women due to development of pyelonephritis. Because probiotic therapy is readily available without a prescription, a review of their efficacy in the prevention of UTI may aid consumers in making informed decisions about potential prophylactic therapy. Institutions and caregivers also need evidence-based synopses of current evidence to make informed patient care decisions.

Objectives: Compared to placebo or no therapy, did probiotics (any formulation) provide a therapeutic advantage in terms of morbidity and mortality, when used to prevent UTI in susceptible patient populations?Compared to other prophylactic interventions, including drug and non-drug measures (e.g. continuous antibiotic prophylaxis, topical oestrogen, cranberry juice), did probiotics (any formulation) provide a therapeutic advantage in terms of morbidity and mortality when used to prevent UTIs in susceptible patient populations?

Search methods: We searched the Cochrane Kidney and Transplant Specialised Register to 21 September 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.

Selection criteria: Randomised controlled trials (RCTs) of susceptible patients (e.g. past history of UTI) or healthy people in which any strain, formulation, dose or frequency of probiotic was compared to placebo or active comparators were included.

Data collection and analysis: All RCTs and quasi-RCTs (RCTs in which allocation to treatment was obtained by alternation, use of alternate medical records, date of birth or other predictable methods) looking at comparing probiotics to no therapy, placebo, or other prophylactic interventions were included. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes.

Main results: We included nine studies that involved 735 people in this review. Four studies compared probiotic with placebo, two compared probiotic with no treatment, two compared probiotics with antibiotics in patients with UTI, and one study compared probiotic with placebo in healthy women. All studies aimed to measure differences in rates of recurrent UTI.Our risk of bias assessment found that most studies had small sample sizes and reported insufficient methodological detail to enable robust assessment. Overall, there was a high risk of bias in the included studies which lead to inability to draw firm conclusions and suggesting that any reported treatment effects may be misleading or represent overestimates.We found no significant reduction in the risk of recurrent symptomatic bacterial UTI between patients treated with probiotics and placebo (6 studies, 352 participants: RR 0.82, 95% CI 0.60 to 1.12; I(2) = 23%) with wide confidence intervals, and statistical heterogeneity was low. No significant reduction in the risk of recurrent symptomatic bacterial UTI was found between probiotic and antibiotic treated patients (1 study, 223 participants: RR 1.12, 95% CI 0.95 to 1.33).The most commonly reported adverse effects were diarrhoea, nausea, vomiting, constipation and vaginal symptoms. None of the included studies reported numbers of participants with at least one asymptomatic bacterial UTI, all-cause mortality or those with at least one confirmed case of bacteraemia or fungaemia. Two studies reported study withdrawal due to adverse events and the number of participants who experienced at least one adverse event. One study reported withdrawal occurred in six probiotic participants (5.2%), 15 antibiotic participants (12.2%), while the second study noted one placebo group participant discontinued treatment due to an adverse event.

Authors' conclusions: No significant benefit was demonstrated for probiotics compared with placebo or no treatment, but a benefit cannot be ruled out as the data were few, and derived from small studies with poor methodological reporting.There was limited information on harm and mortality with probiotics and no evidence on the impact of probiotics on serious adverse events. Current evidence cannot rule out a reduction or increase in recurrent UTI in women with recurrent UTI who use prophylactic probiotics. There was insufficient evidence from one RCT to comment on the effect of probiotics versus antibiotics.

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Conflict of interest statement

  1. Erin M Schwenger: None known

  2. Aaron M Tejani: None known

  3. Peter S Loewen: None known

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Probiotics versus placebo in adults and children, Outcome 1 Symptomatic bacterial UTI.
1.2
1.2. Analysis
Comparison 1 Probiotics versus placebo in adults and children, Outcome 2 Worst case scenario ‐ symptomatic bacterial UTI.
2.1
2.1. Analysis
Comparison 2 Probiotics versus antibiotics in women, Outcome 1 Symptomatic bacterial UTI.
2.2
2.2. Analysis
Comparison 2 Probiotics versus antibiotics in women, Outcome 2 Worst case scenario probiotics ‐ symptomatic bacterial UTI.
2.3
2.3. Analysis
Comparison 2 Probiotics versus antibiotics in women, Outcome 3 Worst case scenario antibiotics ‐ symptomatic bacterial UTI.
3.1
3.1. Analysis
Comparison 3 Probiotics versus control in children with vesicoureteric reflux, Outcome 1 Symptomatic bacterial UTI.
4.1
4.1. Analysis
Comparison 4 Worst case scenario imputation ‐ symptomatic bacterial UTI, Outcome 1 Placebo comparison.
4.2
4.2. Analysis
Comparison 4 Worst case scenario imputation ‐ symptomatic bacterial UTI, Outcome 2 Antibiotic comparison ‐ worst case probiotics.
4.3
4.3. Analysis
Comparison 4 Worst case scenario imputation ‐ symptomatic bacterial UTI, Outcome 3 Antibiotic comparison ‐ worst case antibiotics.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Baerheim 1994 {published data only}
    1. Baerheim A, Larsen E, Digranes A. Vaginal application of lactobacilli in the prophylaxis of recurrent lower urinary tract infection in women. Scandinavian Journal of Primary Health Care 1994;12(4):239‐43. [MEDLINE: ] - PubMed
Czaja 2007 {published data only}
    1. Czaja CA, Stapleton AE, Yarova‐Yarovaya Y, Stamm WE. Phase I trial of a Lactobacillus crispatus vaginal suppository for prevention of recurrent urinary tract infection in women. Infectious Diseases in Obstetrics & Gynecology 2007;2007:35387. [MEDLINE: ] - PMC - PubMed
Ferrara 2009 {published data only}
    1. Ferrara P, Romaniello L, Vitelli O, Gatto A, Serva M, Cataldi L. Cranberry juice for the prevention of recurrent urinary tract infections: a randomized controlled trial in children. Scandinavian Journal of Urology & Nephrology 2009;43(5):369‐72. [MEDLINE: ] - PubMed
Kontiokari 2001 {published data only}
    1. Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry‐lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 2001;322(7302):1‐5. [MEDLINE: ] - PMC - PubMed
Lee 2007a {published data only}
    1. Lee SJ, Kim HJ, Shim YH, Lee JW. The effect of probiotic prophylaxis for preventing recurrent urinary tract infection in children with persistent primary vesicoureteral reflux [abstract no: COD. PP 81]. Pediatric Nephrology 2006;21(10):1542. [CENTRAL: CN‐00724966]
    1. Lee SJ, Shim YH, Cho SJ, Lee JW. Probiotics prophylaxis in children with persistent primary vesicoureteral reflux. Pediatric Nephrology 2007;22(9):1315‐20. [MEDLINE: ] - PubMed
NAPRUTI Study II 2006 {published data only}
    1. Beerepoot MA, Stobberingh EE, Geerlings SE. A study of non‐antibiotic versus antibiotic prophylaxis for recurrent urinary‐tract infections in women (the NAPRUTI study) [Onderzoek naar niet‐antibiotische versus antibiotische profylaxe bij vrouwen met recidiverende urineweginfecties (de NAPRUTI‐studie)]. Nederlands Tijdschrift voor Geneeskunde 2006;150(10):574‐5. [MEDLINE: ] - PubMed
    1. Beerepoot MA, Ter Riet G, Nys S, Wal WM, Borgie CAJM, Reijke TM, et al. Lactobacilli versus antibiotics to prevent urinary tract infections: A randomized, double‐blind, noninferiority trial in postmenopausal women [Lactobacillen versus antibiotica ter preventie van urineweginfecties: 'Non‐in feriority'‐studie bij post men opauzale vrouwen]. Nederlands Tijdschrift voor Geneeskunde 2013;157(10):A5674. [EMBASE: 2013248979]
    1. Beerepoot MA, Ter Riet G, Nys S, Wal WM, Borgie CA, Reijke TM, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double‐blind, noninferiority trial in postmenopausal women. Archives of Internal Medicine 2012;172(9):704‐12. [MEDLINE: ] - PubMed
    1. Beerepoot MA, Heijer CD, Penders J, Prins JM, Stobberingh EE, Geerlings SE. Predictive value of Escherichia coli susceptibility in strains causing asymptomatic bacteriuria for women with recurrent symptomatic urinary tract infections receiving prophylaxis. Clinical Microbiology & Infection 2012;18(4):E84‐90. [MEDLINE: ] - PubMed
    1. Beerepoot MA, Wal WM, Nys S. Lactobacillus rhamnosus gr‐1 and l. Reuteri rc‐14 versus trimethoprim‐sulfamethoxazole (TMP/SMX) in the prevention of recurrent urinary tract infections (RUTIs) in postmenopausal women: a randomized double‐blind non‐inferiority trial [abstract no: L1‐1656a]. 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); 2012 Sep 12‐15; San Francisco (CA). 2012.
Reid 1992 {published data only}
    1. Reid G, Bruce AW, Taylor M. Influence of three‐day antimicrobial therapy and lactobacillus vaginal suppositories on recurrence of urinary tract infections. Clinical Therapeutics 1992;14(1):11‐6. [MEDLINE: ] - PubMed
Reid 2003 {published data only}
    1. Reid G, Charbonneau D, Erb J, Kochanowski B, Beuerman D, Poehner R, et al. Oral use of Lactobacillus rhamnosus GR‐1 and L. fermentum RC‐14 significantly alters vaginal flora: randomized, placebo‐controlled trial in 64 healthy women. FEMS Immunology & Medical Microbiology 2003;35(2):131‐4. [MEDLINE: ] - PubMed
Stapleton 2011 {published and unpublished data}
    1. Stapleton AE, Au‐Yeung M, Hooton TM, Fredricks DN, Roberts PL, Czaja CA, et al. Randomized, placebo‐controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clinical Infectious Diseases 2011;52(10):1212‐7. [MEDLINE: ] - PMC - PubMed

References to studies excluded from this review

Colodner 2003 {published data only}
    1. Colodner R, Edelstein H, Chazan B, Raz R. Vaginal colonization by orally administered Lactobacillus rhamnosus GG. Israel Medical Association Journal: Imaj 2003;5(11):767‐9. [MEDLINE: ] - PubMed
Dani 2002 {published data only}
    1. Dani C, Biadaioli R, Bertini G, Martelli E, Rubaltelli FF. Probiotics feeding in prevention of urinary tract infection, bacterial sepsis and necrotizing enterocolitis in preterm infants. A prospective double‐blind study. Biology of the Neonate 2002;82(2):103‐8. [MEDLINE: ] - PubMed
Manley 2007 {published data only}
    1. Manley K, Fraenkel M, Mayall B, Power D. Yoghurt and VRE: Can a probiotic make a difference? [abstract no: 007]. Journal of Renal Nutrition 2008;18(3 Suppl 1):S3.
    1. Manley KJ, Fraenkel MB, Mayall BC, Power DA. Probiotic treatment of vancomycin‐resistant enterococci: a randomised controlled trial. Medical Journal of Australia 2007;186(9):454‐7. [MEDLINE: ] - PubMed
Mohseni 2013 {published data only}
    1. Mohseni MJ, Aryan Z, Emamzadeh‐Fard S, Paydary K, Mofid V, Joudaki H, et al. Combination of probiotics and antibiotics in the prevention of recurrent urinary tract infection in children. Iranian Journal of Pediatrics 2013;23(4):430‐8. [MEDLINE: ] - PMC - PubMed
Molander 1990 {published data only}
    1. Molander U, Milsom I, Ekelund P, Mellstrom D, Eriksson O. Effect of oral oestriol on vaginal flora and cytology and urogenital symptoms in the post‐menopause. Maturitas 1990;12(2):113‐20. [MEDLINE: ] - PubMed
NCT00900653 {published data only}
    1. NCT00900653. Low dose estriol with lactobacilli (Gynoflor) treatment for preventing recurrent urinary tract infection in postmenopausal women: a randomized, open, parallel‐group study. www.clinicaltrials.gov/ct2/show/NCT00900653 (accessed 21 September 2015).
Pushkarev 2005 {published data only}
    1. Pushkarev AM. Efficacy of probiotic bactisporin in therapy of intrahospital urinary infection. Urologiia (Moscow, Russia) 2005, (4):48‐53. [MEDLINE: ] - PubMed
Ranganathan 2009 {published data only}
    1. Ranganathan N, Friedman EA, Tam P, Rao V, Ranganathan P, Dheer R. Probiotic dietary supplementation in patients with stage 3 and 4 chronic kidney disease: a 6‐month pilot scale trial in Canada. Current Medical Research & Opinion 2009;25(8):1919‐30. [MEDLINE: ] - PubMed
    1. Ranganathan N, Ranganathan P, Friedman EA, Joseph A, Delano B, Goldfarb DS, et al. Pilot study of probiotic dietary supplementation for promoting healthy kidney function in patients with chronic kidney disease. Advances in Therapy 2010;27(9):634‐47. [MEDLINE: ] - PubMed

References to studies awaiting assessment

Reid 1995 {published data only}
    1. Reid G, Bruce AW, Taylor M. Instillation of Lactobacillus and stimulation of indigenous organisms to prevent recurrence of urinary tract infections. Microecology & Therapy 1995;23:32‐45.
Skerk 2010 {published data only}
    1. Skerk V, Ferincevic R, Markotic A, Andrasevic S, Milosevic V, Vargovic M, et al. Research on the efficacy of prophylactic use of Acidosalus probiotic in women with recurrent cystitis [Ispitivanje djelotvornosti profilakticke primjene probiotika Acidosalus u zena s rekurentnim cistitisom]. Infektoloski Glasnik 2010;30(1):21‐5. [EMBASE: 2010599396]

References to ongoing studies

NCT00781625 {published data only}
    1. NCT00781625. Probiotics/lactobacillus as a prophylactic aid in recurrent bacterial cystitis in women. a randomized, prospective, double‐blinded, placebo controlled, multi‐center study. www.clinicaltrials.gov/ct2/show/NCT00781625 (accessed 21 September 2015).
ProSCIUTTU Study 2014 {published data only}
    1. Toh SL, Lee BS, Ryan S, Simpson J. Prophylaxis of spinal cord injury urinary tract infection therapeutic trial (ProSCIUTTU): protocol [abstract]. 53rd ISCoS Annual Scientific Meeting; 2014 Sept 2‐4; Maastricht, Netherlands. 2014.

Additional references

Albert 2004
    1. Albert X, Huertas I, Pereiró I, Sanfélix J, Gosalbes V, Perrotta C. Antibiotics for preventing recurrent urinary tract infection in non‐pregnant women. Cochrane Database of Systematic Reviews 2004, Issue 3. [DOI: 10.1002/14651858.CD001209.pub2] - DOI - PMC - PubMed
Bruce 1988
    1. Bruce AW, Reid G. Intravaginal instillation of lactobacilli for the prevention of recurrent urinary tract infections. Canadian Journal of Microbiology 1988;34(3):339‐43. [MEDLINE: ] - PubMed
CDC 2000
    1. Centers for Disease Control and Prevention (CDC). Monitoring hospital‐acquired infections to promote patient safety‐‐United States, 1990‐1999.[Erratum appears in MMWR Morb Mortal Wkly Rep 2000 Mar 10;49(9):189‐90]. MMWR ‐ Morbidity & Mortality Weekly Report 2000;49(8):149‐53. [MEDLINE: ] - PubMed
Christensen 2001
    1. Christensen J, Jepsen OB. Reduced rates of hospital acquired UTI in medical patients. Prevalence surveys indicate effect of active infection control programmes. Journal of Hospital Infection 2001;47(1):36‐40. [MEDLINE: ] - PubMed
Falagas 2006
    1. Falagas ME, Betsi GI, Athanasiou S. Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. Journal of Antimicrobial Chemotherapy 2006;58(2):266‐72. [MEDLINE: ] - PubMed
Foxman 2003
    1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Disease‐a‐Month 2003;49(2):53‐70. [MEDLINE: ] - PubMed
Grin 2013
    1. Grin PM, Kowalewska PM, Alahazanni W, Fox‐Robichaud AE. Lactobacillus for preventing recurrent urinary tract infections in women: meta‐analysis. Canadian Journal of Urology 2013;20(1):6607‐14. [MEDLINE: ] - PubMed
Hawthorn 1990
    1. Hawthorn LA, Reid G. Exclusion of uropathogen adhesion to polymer surfaces by Lactobacillus acidophilus. Journal of Biomedical Materials Research 1990;24(1):39‐46. [MEDLINE: ] - PubMed
Heineman 2000
    1. Heinemann C, Hylckama Vlieg JE, Janssen DB, Busscher HJ, Mei HC, Reid G. Purification and characterization of a surface‐binding protein from Lactobacillus fermentum RC‐14 that inhibits adhesion of Enterococcus faecalis 1131. FEMS Microbiology Letters 2000;190(1):177‐80. [MEDLINE: ] - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. [MEDLINE: ] - PMC - PubMed
Higgins 2011
    1. Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Howes 2009
    1. Howes DS. Urinary tract infections, female. emedicine.medscape.com/article/778670‐overview (accessed August 2010).
Howes 2010
    1. Howes DS, Pillow MT. Urinary tract infections, male. emedicine.medscape.com/article/778578‐overview (accessed August 2010).
Jepson 2012
    1. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews 2012, Issue 10. [DOI: 10.1002/14651858.CD001321.pub5] - DOI - PMC - PubMed
Maki 2001
    1. Maki D, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerging Infectious Diseases 2001;7(2):342‐7. [MEDLINE: ] - PMC - PubMed
Osset 2001
    1. Osset J, Bartolome RM, Garcia E, Andreu A. Assessment of the capacity of Lactobacillus to inhibit the growth of uropathogens and block their adhesion to vaginal epithelial cells. Journal of Infectious Diseases 2001;183(3):485‐91. [MEDLINE: ] - PubMed
Ouslander 1995
    1. Ouslander JG, Schnelle JF, Uman G, Fingold S, Nigam JG, Tuico E, et al. Predictors of successful prompted voiding among incontinent nursing home residents. JAMA 1995;273(17):1366‐70. [MEDLINE: ] - PubMed
Perrotta 2008
    1. Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD005131.pub2] - DOI - PubMed
Richards 2001
    1. Richards C, Emori TG, Peavy G, Gaynes RP. Promoting quality through measurement of performance and response: prevention success stories. Emerging Infectious Diseases 2001;7(2):299‐301. [MEDLINE: ] - PMC - PubMed
Richards 2004
    1. Richards CL. Urinary tract infections in the frail elderly: Issues for diagnosis, treatment and prevention. International Urology & Nephrology 2004;36(3):457‐63. [MEDLINE: ] - PubMed
Saint 2000
    1. Saint S, Wiese J, Amory JK, Bernstein ML, Patel UD, Zemencuk JK, et al. Are physicians aware of which of their patients have indwelling urinary catheters?. American Journal of Medicine 2000;109(6):476‐80. [MEDLINE: ] - PubMed
Schnelle 1995
    1. Schnelle JF, McNees P, Crooks V, Ouslander JG. The use of a computer‐based model to implement an incontinence management program. Gerontologist 1995;35(5):656‐65. [MEDLINE: ] - PubMed
Schrezenmeir 2001
    1. Schrezenmeir J, Vrese M. Probiotics, prebiotics, and synbiotics ‐ approaching a definition. American Journal of Clinical Nutrition 2001;73(2 Suppl):361S‐364S. [MEDLINE: ] - PubMed
Velraeds 1998
    1. Velraeds MM, Belt‐Gritter B, Mei HC, Reid G, Busscher HJ. Interference in initial adhesion of uropathogenic bacteria and yeasts to silicone rubber by a Lactobacillus acidophilus biosurfactant. Journal of Medical Microbiology 1998;47(12):1081‐5. [MEDLINE: ] - PubMed
Williams 2011
    1. Williams G, Craig JC. Long‐term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database of Systematic Reviews 2011, Issue 3. [DOI: 10.1002/14651858.CD001534.pub3] - DOI - PubMed

References to other published versions of this review

Schwenger 2010
    1. Schwenger EM, Tejani AM, Loewen PS. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database of Systematic Reviews 2010, Issue 10. [DOI: 10.1002/14651858.CD008772] - DOI - PMC - PubMed

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