Effectiveness of prophylactic oral and/or vaginal probiotic supplementation in the prevention of recurrent urinary tract infections: A randomized, double-blind, placebo-controlled trial

Varsha Gupta; Paola Mastromarino; Ritu Garg

doi:10.1093/cid/ciad766

Effectiveness of prophylactic oral and/or vaginal probiotic supplementation in the prevention of recurrent urinary tract infections: A randomized, double-blind, placebo-controlled trial

Clin Infect Dis. 2023 Dec 12:ciad766. doi: 10.1093/cid/ciad766. Online ahead of print.

Authors

Varsha Gupta¹, Paola Mastromarino², Ritu Garg³

Affiliations

¹ Professor & Head, Department of Microbiology, Government Medical College & Hospital, Sector-32, Chandigarh, India.
² Department of Public Health Sciences and Infectious Diseases, Section of Microbiology, Sapienza University, Rome, Italy.
³ Professor & Head, Department of Microbiology, Dr. B R Ambedkar State Institute of Medical Sciences, Sahibzada Ajit Singh Nagar, Mohali 160055, Punjab, India.

PMID: 38084984
DOI: 10.1093/cid/ciad766

Abstract

Background: Widespread antibiotic resistance has sparked interest in the lookout for non-antibiotic strategies, particularly focusing on probiotics for the prevention of recurrent urinary tract infections (UTIs). We evaluated the effectiveness of prophylactic probiotic supplementation through oral and intravaginal routes in the prevention of recurrent UTIs.

Methods: This double-blind, placebo-controlled study enrolled 174 premenopausal women with a history of recurrent UTIs and randomized them to either of the four treatment groups, namely, Placebo (G1, oral placebo+vaginal placebo); Oral probiotic (G2, oral lactic acid bacteria and bifidobacteria+vaginal placebo); Vaginal probiotic (G3, oral placebo+vaginal lactobacilli); and Probiotic combination (oral lactic acid bacteria and bifidobacteria+vaginal lactobacilli), for 4 months. Participants were followed-up for symptomatic UTIs for one year. The primary endpoints were the number of symptomatic UTIs at 4 months, the proportion of subjects with at least one symptomatic UTI, and the time to the first symptomatic UTI.

Results: The incidence of UTI at 4 months in G1, G2, G3 and G4 was 70.4%, 61.3%, 40.9%, and 31.8%, respectively. The mean number of symptomatic UTI recurrence at 4 months was significantly lower (p<0.05) in G3 (1.06) and G4 (1.07) compared to G1 (2.1) and G2 (1.63). Further, the time to first symptomatic UTI (days) was significantly longer (p<0.05) in G3 (123.8) and G4 (141.8) compared to G1 (69.3) and G2 (71.9). Probiotic supplementations were well tolerated with no serious adverse events.

Conclusion: Prophylactic supplementation with either vaginal probiotics or in combination with oral probiotics demonstrated effectiveness in preventing recurrent symptomatic UTI episodes.

Keywords: Antibiotic resistance; Evanew; Flora-Balance; Florimax; Probiotics; Recurrent urinary tract infections; Visbiome.