Wiley
CME: Probiotics reduce the likelihood of recurrence in women with frequent urinary tract infections
October 17, 2024
CME CREDITS - 0.50
POEMS (Patient-Oriented Evidence that Matters)
Clinical question:
Do oral or vaginal probiotics (or both) reduce the likelihood of recurrence in premenopausal adult women with frequent urinary tract infections?
Bottom line:
Lactobacillus-containing probiotics (orally, vaginally, or both) reduce the incidence of recurrent UTI and prolong the time to the next UTI in premenopausal women with frequent UTIs. Vaginal probiotics (with or without oral probiotics) outperform oral probiotics alone. Vaginal probiotics alone provide a similar benefit to oral plus vaginal supplementation and would seem to be the least invasive and least costly option. (LOE = 1b)
Synopsis:
This study from India identified 174 women ages 18 to 45 years who had experienced at least 3 uncomplicated UTIs in the past year. The women's mean age was 36 years, and the mean number of UTIs in the previous year was slightly more than 5. The women were randomized into 1 of 4 groups: oral and vaginal placebos, oral probiotic and vaginal placebo, oral placebo and vaginal probiotic, or both oral and vaginal probiotics. The oral probiotic was 112.5 billion live lyophilized lactic acid bacteria and bifidobacteria; the vaginal probiotic contained 1 billion units of 3 lactobacillus strains. The groups were balanced at the start of the study, and analysis appears to have been by intention to treat. At 4 months, a symptomatic UTI had occurred in 70% in the placebo-only group, 61% in the oral probiotic group, 41% in the vaginal probiotic group, and 32% in the group that received both. The differences between placebo only and the active treatments were statistically significant for the vaginal and vaginal plus oral probiotic groups. Results at 12 months were similar, with rates of UTI of 95%, 77%, 61%, and 55%, respectively. Patients were asked to rate their degree of improvement and most in the vaginal and vaginal plus oral probiotic groups rated themselves as "much improved." No adverse events were reported (which suggests they didn't look very hard, since even the placebo groups in every trial report adverse events).
Mark H. Ebell, MD, MS
Reference:
Gupta V, Mastromarino P, Garg R. 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 2024;78(5):1154-1161. https://pubmed.ncbi.nlm.nih.gov/38084984/
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