Probiotics to prevent urinary tract infections: the rationale and evidence.
For over 30 years, urologists have recognized in females, that urinary pathogens almost always infect the host through ascension from the rectum, vagina to the urethra and bladder. Likewise, the Lactobacillus organisms that predominate in the vagina of healthy women, spread from the rectum and perineum and form a barrier in the vagina to bladder entry by uropathogens. The concept of artificially boosting the lactobacilli numbers through probiotic instillation has long been conceived, but only in recent years shown to be possible. Not all lactobacilli are effective, and to date clinical efficacy only exists for Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri B-54 and RC-14. These strains are only commercially available in Austria, and therefore for most urologists, while some probiotic organisms may reduce the recurrences of bladder cancer or oxaluria, no probiotics can be recommended widely to prevent UTI at present.
Reid
Gregor
G
Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, 268 Grosvenor Street, N6A 4V2, London, Ontario, Canada. gregor@uwo.ca
Bruce
Andrew W
AW
D000282:Administration, Intravaginal; D000284:Administration, Oral; D019317:Evidence-Based Medicine; D005260:Female; D052776:Female Urogenital Diseases / Q000517:prevention & control*; D006801:Humans; D007778:Lactobacillus; D008297:Male; D052801:Male Urogenital Diseases; D011322:Primary Prevention / Q000379:methods; D019936:Probiotics / Q000008:administration & dosage*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000517:prevention & control*