Abstract
Probiotics, beneficial living microorganisms, have been proven to be effective in preventing gastrointestinal infections, but their effect in preventing urinary tract infection (UTI) is inconclusive. A prospective randomized controlled study was done to compare the preventive effect of probiotics with conventional antibiotics in children with persistent primary vesicoureteral reflux (VUR). One hundred twenty children who had had persistent primary VUR after antibiotic prophylaxis for 1 year were randomly allocated into a probiotics (Lactobacillus acidophilus 108 CFU/g 1 g b.i.d., n = 60) or an antibiotics (trimethoprim/sulfamethoxazole 2/10 mg/kg h.s., n = 60) prophylaxis group during the second year of follow-up. The incidence of recurrent UTI was 18.3% (11/60) in the probiotics group, which was not different from 21.6%(13/60) in the antibiotic group (P = 0.926). The causative organisms of recurrent UTI were not significantly different between the two groups (P = 0.938). Even after stratification by VUR grade, age, gender, phimosis, voiding dysfunction and renal scar, the incidence of recurrent UTI did not differ significantly between the two groups (P > 0.05). The development of new renal scar was not significantly different between the two groups (P > 0.05). In conclusion, probiotics prophylaxis was as effective as antibiotic prophylaxis in children with persistent primary VUR.
Similar content being viewed by others
References
Elder JS, Peters CA, Arant BS Jr, Ewalt DH, Hawtery CE, Hasselblad V (1997) Pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children. J Urol 157:1846–1851
Lettgen B (1996) Prevention of recurrent urinary tract infection in female children. Curr Ther Res 59:562–565
Williams G, Lee A, Craig J (2001) Antibiotics for the prevention of urinary tract infection in children: a systematic review of randomized controlled trials. J Pediatr 138:868–874
William GJ, Lee A, Craig JC (2002) Longterm antibiotics for preventing recurrent urinary tract infection in children (Cochrane review) In the Cochrane library, Issue 3. Update software, Oxford
Ladhani S, Gransden W (2003) Increasing antibiotic resistance among urinary tract isolates. Arch Dis Child 88:444–445
Evaluation of health and nutritional properties of probiotics in food including powder milk and live lactic acid bacteria. Food and Agriculture Organization of the United States and World Health Organization Expert Consultation Report. Available at https://doi.org/www.fao.org/es/ESN/Probio/probio.html2001.Cordoban, Argentina, 1–4 October 2001
Fuller R (1989) Probiotics in man and animals. J Appl Bacteriol 66:365–378
Falk PG, Hooper LV, Midtvedt T, Gordon JI (1998) Creating and maintaining the gastrointestinal ecosystem. What we know and need to know from gnotobiology. Microbiol Mol Biol Rev 62:1157–1170
Drisko J, Giles C, Bischoff B (2003) Probiotics in health maintenance and disease prevention. Altern Med Rev 8:143–155
Fedorak RN, Madsen K (2004) Probiotics and prebiotics in gastrointestinal disorders. Curr Opin Gastroenterol 20:146–155
Bruce AW, Reid G (1988) Intravaginal instillation of lactobacilli for prevention of recurrent urinary tract infection. Can J Microbiol 34:49–52
Reid G, Bruce AW, Taylor M (1995) Instillation of lactobacillus and stimulation of indigenous organisms to prevent recurrence of urinary tract infections. Microecol Ther 23:32–45
Cadieux P, Burton J, Gardiner G, Braunstein I, Bruce AW, Kang CY, Reid G (2002) Lactobacillus strains and vaginal ecology. JAMA 287:1940–1946
Kontiokari T, Laitinen J, Jarvi L, Pokka T, Sundqvist K, Uhari M (2003) Dietary factors protecting women from urinary tract infection. Am J Clin Nutr 77:600–604
Reid G, Charbonneau D, Erb J, Kochanowski B, Beuerman D, Poehner R, Bruce AW (2003) Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy woman. FEMS Immunol Microbiol 35:131–134
Gardiner GE, Heinemann C, Bruce AW, Beuerman D, Reid G (2002) Persistence of Lactobacillus fermentum RC-14 and Lactobacillus rhamnosus GR-1, but not L. rhamnosus GG in the human vagina as demonstrated by randomly amplified polymorphic DNA. Clin Diagn Lab Immunol 9:2002–2008
Reid G, Bruce AW, Talyer M (1992) Influence of three day antimicrobial therapy and lactobacillus suppositories on recurrent urinary tract infection. Clin Ther 14:11–16
Reid G, Hammond JA, Bruce AW (2003) Effect of lactobacilli oral supplement on the vaginal microflora of antibiotic treated patients: randomized placebo controlled study. Nutraceut Food 8:145–148
Marild S, Hansson S, Jodal U, Oden A, Svedberg K (2004) Protective effect of breastfeeding against urinary tract infection. Acta Paediatr 93:164–168
Dani C, Biadaioli R, Bertini G, Martelli E, Rubaltelli FF (2002) Probiotics feeding in prevention of urinary tract infection, bacterial sepsis and necrotizing enterocolitis in preterm infants. A prospective double-blind study. Biol Neonate 82:103–108
Gerasimov SV (2004) Probiotic prophylaxis in pediatric recurrent urinary tract infections. Clin Pediatr 43:95–98
Lohr JA, Numley DH, Howards SS, Ford RF (1977) Prevention of recurrent urinary tract infection in girls. Pediatrics 59:562–565
Newman D (1915) The treatment of cystitis by intravesical injection of lactic bacillus cultures. Lancet 14:330–332
Bruce AW, Chadwick P, Hassan A, VanCott GF (1973) Recurrent urethritis in women. Can Med Assoc J 108:973–976
Gupta K, Stapleton AE, Hooton TM, Roberts PL, Fennell CL, Stamm WE (1998) Inverse association of H2O2-producing lactobacilli and vaginal Escherichia coli colonization in women with recurrent urinary tract infection. J Infect Dis 178:446–450
Chan RCY, Bruce AW, Reid G (1984) Adherence of cervical, vaginal and distal urethral normal microbial flora to human uroepithelial cells and the inhibition of adherences of uropathogens by competitive exclusion. J Urol 131:596–601
Reid G, Cook RL, Bruce AW (1987) Examination of strains of lactobacilli for properties that may influence bacterial interference in the urinary tract. J Urol 138:330–335
Velraeds MC, van der Mei HC, Reid G, Busscher HJ (1996) Inhibition of initial adhesion of uropathogenic Enterococcus faecalis by biosurfactant from lactobacillus isolates. Appl Environ Microbiol 62:1958–1963
McGroarty JA, Reid G (1998) Detection of a lactobacillus substance which inhibits Escherichia coli. Can J Microbiol 34:974–978
Shahani AKM, Vakil JR, Kilara A (1976) Natural antibiotic activity of Lactobacillus acidophilus and bulgaricus. I. Cultural condition for the production of antibiosis. Cultured Dairy Prod J 11:14–17
Osset J, Bartolome RM, Garcia E, Andreu A (2001) Assessment of the capacity of lactobacillus to inhibit the growth of uropathogens and block their adhesion to vagina epithelial cells. J Infect Dis 183:485–491
Saunders ME, Klaenhammer TR (2001) Invited review: The scientific basis of Lactobacillus acidophilus NCFM functionality as a probiotic. J Dairy Sci 84:319–331
Reid G, Chan RCY, Bruce AW, Costerton JW (1985) Prevention of urinary tract infection in rats with an indigenous lactobacillus casei strain. Infect Immun 49:320–324
Asahara T, Nomoto K, Watanuki M, Yokokura T (2001) Antimicrobial activity of intraurethrally administered probiotic Lactobacilli casei in a murine model of Escherichia coli urinary tract infection. Antimicrob Agents Chemother 45:1751–1760
Reid G, Bruce AW (2006) Probiotics to prevent urinary tract infections: the rationale and evidence. World J Urol 24:28–32
Reid G (2005) The importance of guidelines in the development and application of probiotics. Curr Pharm Des 11:11–16
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, S.J., Shim, Y.H., Cho, S.J. et al. Probiotics prophylaxis in children with persistent primary vesicoureteral reflux. Pediatr Nephrol 22, 1315–1320 (2007). https://doi.org/10.1007/s00467-007-0507-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-007-0507-1