Probiotics proved more effective than a placebo at reducing the risk for UTI recurrence in children with a normal urinary tract after their first episode of febrile UTI, according to results of a randomized clinical trial published in the Journal of the Pediatric Infectious Diseases Society.
“In this study, we compared the effect of probiotic and placebo prophylaxis in young children with uncomplicated UTI and found that probiotics, with a higher rate of composite cure observed after 18 months of therapy, were superior to placebo,” Simin Sadeghi-bojd, MD, PhD, and colleagues wrote. “The lower incidence of UTI recurrence in the probiotic group suggests that greater UTI-free survival with probiotics provides additional clinical benefit for children with a normal urinary tract.”
Long-term antibiotic regimens are often prescribed to prevent UTI recurrence in infants and young children, but this practice has been called into question over the past few years because of adverse events and an increase in the development of drug resistance, according to the study authors. The AAP also recently reaffirmed its 2011 clinical practice guideline, which stated that antimicrobial prophylaxis is ineffective at curbing the recurrence of febrile UTIs. Accordingly, researchers are evaluating other, “nonantibiotic” measures, including applying topical estrogen, asking patients to drink cranberry juice or take probiotics to prevent recurrent infection.
Sadeghi-bojd and colleagues randomly assigned 181 children, aged 4 months to 5 years, with a normal urinary tract following recovery from their first febrile UTI to receive either a probiotic mixture or placebo. UTI-free survival at 18 months was the primary endpoint, with median time to first UTI as the secondary endpoint.
At 18 months, composite cure was observed in 96.7% of patients who received the probiotic mixture and 83.3% who received the placebo, according to the study. The median time to first UTI recurrence in the probiotic group was 3.5 months (range, 1-4 months) and 6.5 months (range, 2-14 months) in the placebo group. Girls displayed higher recurrence rates for both groups than boys, with 11.5% vs. 0% in the probiotic group and 27.4% vs. 5% in the placebo group.
“Given the limitations of our study, additional investigation is needed to better understand the risks and benefits of probiotic prophylaxis,” the researchers wrote. “This type of study should be powered to examine the efficacy of prophylaxis in older patients and in those with and those without [vesicoureteral reflux]. Selection of the best probiotic strains, optimal dosing, and appropriate duration of therapy are important issues that also must be addressed in future clinical trials.” – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.