April 20, 2011
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Vaginal probiotic decreased recurrent UTIs in premenopausal women

Stapleton AE. Clin Infect Dis. 2011;52:1212-1217.

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A Lactobacillus crispatus intravaginal suppository probiotic reduced the rate for recurrent urinary tract infections by approximately 50% in premenopausal women with recurring infections, according to results from a phase 2 study.

Researchers said probiotic treatment “reduced the risk for recurring urinary tract infections (UTIs) almost as effectively as antimicrobial prophylaxis, achieved high-level vaginal colonization in most women, and was well tolerated.”

According to background information in the study, the depletion of vaginal lactobacilli is associated with the risk for UTIs. Therefore, Ann E. Stapleton, MD, of the University of Washington, and colleagues set out to assess the use of L. crispatusintravaginal suppository probiotic (Lactin-V, Osel Inc.) in a cohort of premenopausal women.

From 2006 to 2009, 100 women aged 18 to 40 years were assigned antimicrobials for acute UTI, followed by probiotic (n=50) or placebo for 5 days, then once a week for 10 weeks (n=50). Eligible participants had cystitis with at least one prior UTI treated within the past year. Follow-up was at 1 week and at 10 weeks after the intervention.

Compared with 27% of women who received placebo, 15% of women who received probiotic had at least one recurrent UTI (RR=0.5; 95% CI, 0.2-1.2). In addition, researchers observed an increased level of L. crispatus vaginal colonization among women assigned probiotic (RR=0.07). Conversely, women assigned placebo did not experience an increase (RR=1.1; P< .01).

“In summary, the probiotic treatment in women with recurrent UTI resulted in robust and prolonged colonization with L. crispatus, with a trend of reducing the incidence of recurrent UTI by 50%,” the researchers wrote. “The protective effects of probiotic were even greater in women who achieved the most robust colonization with L. crispatus and reflect an apparent treatment advantage for the probiotic over natural recovery of the vaginal microbiota after an episode of recurrent UTI.”

The researchers said further, larger efficacy trials are needed for at-risk women. – by Ashley DeNyse

Disclosure: Dr. Stapleton reports no relevant financial disclosures.

PERSPECTIVE

UTI is a common indication for antibiotics in community and health care settings and multi-drug resistant UTI pathogens (including CTX-M-producing E. coli) are increasing in frequency. Thus, a preventive intervention that decreases the frequency of infection and antibiotic use is potentially important and might lead to improvements in antimicrobial resistance.

Keith S. Kaye, MD, MPH
Infectious Disease News Editorial Board member

Disclosure: Dr. Kaye reports no relevant financial disclosures

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