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.

This is a preview of subscription content, log in to check access.


  1. 1.

    Anderson GG, Palermo JJ, Schilling JD, Roth R, Heuser J, Hultgren SJ (2003) Intracellular bacterial biofilm-like pods in urinary tract infections. Science 301:105-107

    Article  PubMed  CAS  Google Scholar 

  2. 2.

    Antonio MA, Rabe LK, Hillier SL (2005) Colonization of the rectum by Lactobacillus species and decreased risk of bacterial vaginosis. J Infect Dis 192(3):394–398

    PubMed  Article  Google Scholar 

  3. 3.

    Asahara T, Nomoto K, Watanuki M, Yokokura T (2001) Antimicrobial activity of intraurethrally administered probiotic Lactobacillus casei in a murine model of Escherichia coli urinary tract infection. Antimicrob Agents Chemother 45(6):1751–1760

    Article  PubMed  CAS  Google Scholar 

  4. 4.

    Aso Y, Akaza H, Kotake T, Tsukamoto T, Imai K, Naito S (1995) Preventive effect of a Lactobacillus casei preparation on the recurrence of superficial bladder cancer in a double-blind trial. The BLP Study Group. Eur Urol 27(2):104–109

    PubMed  CAS  Google Scholar 

  5. 5.

    Bacheller CD, Bernstein JM (1997) Urinary tract infections. Med Clin North Am 81:719–730

    Article  PubMed  CAS  Google Scholar 

  6. 6.

    Baerheim A, Larsen E, Digranes A (1994) Vaginal application of lactobacilli in the prophylaxis of recurrent lower urinary tract infection in women. Scand J Prim Health Care 12:239–243

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Bruce AW, Reid G (2003) Probiotics and the urologist. Can J Urol 10(2):1785–1789

    PubMed  Google Scholar 

  8. 8.

    Bruce AW, Chadwick P, Hassan A, VanCott GF (1973) Recurrent urethritis in women. Can Med Assoc J 108:973–976

    PubMed  CAS  Google Scholar 

  9. 9.

    Brumfitt W, Hamilton-Miller JM (1998) Efficacy and safety profile of long-term nitrofurantoin in urinary infections: 18 years’ experience. J Antimicrob Chemother 42:363–371

    Article  PubMed  CAS  Google Scholar 

  10. 10.

    Brumfitt W, Hamilton-Miller JM, Gargan RA, Cooper J, Smith GW (1983) Long-term prophylaxis of urinary infections in women: comparative trial of trimethoprim, methenamine hippurate and topical povidone–iodine. J Urol 130:1110–1114

    PubMed  CAS  Google Scholar 

  11. 11.

    Brumfitt W, Hamilton-Miller JM, Walker S, Roberts D (1992) Cefaclor as a prophylactic agent for recurrent urinary infections: a comparative trial with macrocrystalline nitrofurantoin. Drugs Exp Clin Res 18:239–244

    PubMed  CAS  Google Scholar 

  12. 12.

    Cadieux P, Burton J, Gardiner G, Braunstein I, Bruce AW, Kang CY, Reid G. (2002) Lactobacillus strains and vaginal ecology. JAMA 287:1940–1941

    Article  PubMed  Google Scholar 

  13. 13.

    Campieri C, Campieri M, Bertuzzi V, Swennen E, Matteuzzi D, Stefoni S, Pirovano F, Centi C, Ulisse S, Famularo G, De Simone C (2001) Reduction of oxaluria after an oral course of lactic acid bacteria at high concentration. Kidney Int 60(3):1097–1105

    Article  PubMed  CAS  Google Scholar 

  14. 14.

    Cauci S, Guaschino S, De Aloysio D, Driussi S, De Santo D, Penacchioni P, Quadrifoglio F (2003) Interrelationships of interleukin-8 with interleukin-1beta and neutrophils in vaginal fluid of healthy and bacterial vaginosis positive women. Mol Hum Reprod 9(1):53–58

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Cauci S, McGregor J, Thorsen P, Grove J, Guaschino S (2005) Combination of vaginal pH with vaginal sialidase and prolidase activities for prediction of low birth weight and preterm birth. Am J Obstet Gynecol 192(2):489–496

    Article  PubMed  CAS  Google Scholar 

  16. 16.

    Chan RC, Bruce AW, Reid G (1984) Adherence of cervical, vaginal and distal urethral normal microbial flora to human uroepithelial cells and the inhibition of adherence of gram-negative uropathogens by competitive exclusion. J Urol 131(3):596–601

    PubMed  CAS  Google Scholar 

  17. 17.

    Colodner R, Edelstein H, Chazan B, Raz R (2003) Vaginal colonization by orally administered Lactobacillus rhamnosus GG. Isr Med Assoc J 5(11):767–769

    PubMed  Google Scholar 

  18. 18.

    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(2):103–108

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Darouiche RO, Thornby JI, Cerra-Stewart C, Donovan WH, Hull RA (2005) Bacterial interference for prevention of urinary tract infection: a prospective, randomized, placebo-controlled, double-blind pilot trial. Clin Infect Dis 41(10):1531–1534

    Article  PubMed  Google Scholar 

  20. 20.

    Fraga M, Scavone P, Zunino P (2005) Preventive and therapeutic administration of an indigenous Lactobacillus sp. strain against Proteus mirabilis ascending urinary tract infection in a mouse model. Antonie Van Leeuwenhoek 88(1):25–34

    Article  PubMed  Google Scholar 

  21. 21.

    Gower PR, Roberts AP (1975) Qualitative assessment of midstream urine cultures in the detection of bacteriuria. Clin Nephrol 3(1):10–13

    PubMed  CAS  Google Scholar 

  22. 22.

    Hagberg LA, Bruce AW, Reid G, Svanborg Eden C, Lincoln K, Lidin-Janson G (1989) Colonization of the urinary tract with live bacteria from the normal fecal and urethral flora in patients with recurrent symptomatic urinary tract infections. In: Kass EH, Eden C Svanborg (eds) Host–parasite interactions in urinary tract infections. University of Chicago Press, Chicago, pp 194–197

    Google Scholar 

  23. 23.

    Hopkins WJ, Uehling DT (2002) Vaccine development for the prevention of urinary tract infections. Curr Infect Dis Rep 4(6):509–513

    PubMed  Article  Google Scholar 

  24. 24.

    Kazhina MV, Zhmakin AI, Titov LP (2005) Changes in vaginal microbiocenosis in patients with chronic pelvic inflammatory diseases following antibiotic therapy. Zh Mikrobiol Epidemiol Immunobiol May–June (3):75–78

    Google Scholar 

  25. 25.

    Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M (2001) Randomised trial of cranberry–lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 322:1571

    Article  PubMed  CAS  Google Scholar 

  26. 26.

    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(3):600–604

    PubMed  CAS  Google Scholar 

  27. 27.

    Land MH, Rouster-Stevens K, Woods CR, Cannon ML, Cnota J, Shetty AK (2005) Lactobacillus sepsis associated with probiotic therapy. Pediatrics 115(1):178–181

    PubMed  Google Scholar 

  28. 28.

    Lane MC, Lockatell V, Monterosso G, Lamphier D, Weinert J, Hebel JR, Johnson DE, Mobley HL (2005) Role of motility in the colonization of uropathogenic Escherichia coli in the urinary tract. Infect Immun 73(11):7644–7656

    Article  PubMed  CAS  Google Scholar 

  29. 29.

    Langermann S, Ballou WR (2003) Development of a recombinant FimCH vaccine for urinary tract infections. Adv Exp Med Biol 539(Pt B):635–648

    PubMed  Google Scholar 

  30. 30.

    Laughton J, Devillard E, Heinrichs DE, Reid G, McCormick JK (2004) Cell–cell communication in Gram-positive bacteria: Inhibition of Staphylococcus aureus exotoxin expression by Lactobacillus reuteri. In: American Society for Microbiology Conference on cell–cell communication, Banff, Alberta, July (Abstract)

  31. 31.

    Li X, Lockatell CV, Johnson DE, Lane MC, Warren JW, Mobley HL (2004) Development of an intranasal vaccine to prevent urinary tract infection by Proteus mirabilis. Infect Immun 72(1):66–75

    Article  PubMed  CAS  Google Scholar 

  32. 32.

    Marrs CF, Zhang L, Foxman B (2005) Escherichia coli mediated urinary tract infections: are there distinct uropathogenic E. coli (UPEC) pathotypes? FEMS Microbiol Lett 252(2):183–190

    Article  PubMed  CAS  Google Scholar 

  33. 33.

    Morelli L, Zonenenschain D, Del Piano M, Cognein P (2004) Utilization of the intestinal tract as a delivery system for urogenital probiotics. J Clin Gastroenterol 38(6 Suppl):S107–S110

    Article  PubMed  CAS  Google Scholar 

  34. 34.

    Ocana VS, Elena Nader-Macias M (2004) Production of antimicrobial substances by lactic acid bacteria II: screening bacteriocin-producing strains with probiotic purposes and characterization of a Lactobacillus bacteriocin. Methods Mol Biol 268:347–353

    PubMed  CAS  Google Scholar 

  35. 35.

    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 vaginal epithelial cells. J Infect Dis 183(3):485–491

    Article  PubMed  CAS  Google Scholar 

  36. 36.

    Parham NJ, Pollard SJ, Desvaux M, Scott-Tucker A, Liu C, Fivian A, Henderson IR (2005) Distribution of the serine protease autotransporters of the Enterobacteriaceae among extraintestinal clinical isolates of Escherichia coli. J Clin Microbiol 43(8):4076–4082

    Article  PubMed  CAS  Google Scholar 

  37. 37.

    Pirotta M, Gunn J, Chondros P, Grover S, O’Malley P, Hurley S, Garland S (2004) Effect of Lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial. BMJ 329(7465):548

    Article  PubMed  Google Scholar 

  38. 38.

    Reid G (2005) The importance of guidelines in the development and application of probiotics. Curr Pharm Des 11(1):11–16

    Article  PubMed  CAS  Google Scholar 

  39. 39.

    Reid G, Zorzitto ML, Bruce AW, Jewett MAS, Chan RCY, Costerton JW (1984) The pathogenesis of urinary tract infection in the elderly: the role of bacterial adherence to uroepithelial cells. Curr Microbiol 11(2):67–72

    Article  Google Scholar 

  40. 40.

    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(2):330–335

    PubMed  CAS  Google Scholar 

  41. 41.

    Reid G, Bruce AW, Cook RL, Llano M (1990) Effect on the urogenital flora of antibiotic therapy for urinary tract infection. Scand J Infect Dis 22:43–47

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Reid G, Bruce AW, Taylor M (1992) Influence of three day antimicrobial therapy and lactobacillus suppositories on recurrence of urinary tract infection. Clin Ther 14:11–16

    PubMed  CAS  Google Scholar 

  43. 43.

    Reid G, Charbonneau-Smith R, Lam D, Lacerte M, Kang YS, Hayes KC (1992) Bacterial biofilm formation in the urinary bladder of spinal cord injured patients. Paraplegia 30:711–717

    PubMed  CAS  Google Scholar 

  44. 44.

    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

    Google Scholar 

  45. 45.

    Reid G, Bruce AW, Fraser N, Heinemann C, Owen J, Henning B (2001) Oral probiotics can resolve urogenital infections. FEMS Immunol Med Microbiol 30(1):49–52

    Article  PubMed  CAS  Google Scholar 

  46. 46.

    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 women. FEMS Immunol Med Microbiol 35(2):131–134

    Article  PubMed  CAS  Google Scholar 

  47. 47.

    Reid G, Hammond J-A, 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

    Article  Google Scholar 

  48. 48.

    Reid G, Kim SO, Kohler G (2005) Selection, testing and understanding probiotic microbes. FEMS Immunol Med Microbiol (in press)

  49. 49.

    Seno Y, Kariyama R, Mitsuhata R, Monden K, Kumon H (2005) Clinical implications of biofilm formation by Enterococcus faecalis in the urinary tract. Acta Med Okayama 59:79–87

    PubMed  Google Scholar 

  50. 50.

    Snyder JA, Haugen BJ, Lockatell CV, Maroncle N, Hagan EC, Johnson DE, Welch RA, Mobley HL (2005) Coordinate expression of fimbriae in uropathogenic Escherichia coli. Infect Immun 73(11):7588–7596

    Article  PubMed  CAS  Google Scholar 

  51. 51.

    Strus M, Kucharska A, Kukla G, Brzychczy-Wloch M, Maresz K, Heczko PB (2005) The in vitro activity of vaginal Lactobacillus with probiotic properties against Candida. Infect Dis Obstet Gynecol 13(2):69–75

    Article  PubMed  Google Scholar 

  52. 52.

    Usein CR, Damian M, Tatu-Chitoiu D, Capusa C, Fagaras R, Mircescu G (2003) Comparison of genomic profiles of Escherichia coli isolates from urinary tract infections. Roum Arch Microbiol Immunol 62(3–4):137–154

    PubMed  CAS  Google Scholar 

  53. 53.

    Velraeds MC, van der Belt B, van der Mei HC, Reid G, Busscher HJ (1998) Interference in initial adhesion of uropathogenic bacteria and yeasts silicone rubber by a Lactobacillus acidophilus biosurfactant. J Med Microbiol 49:790–794

    Google Scholar 

Download references


The assistance provided by the Ontario Challenge Fund, NSERC and CIHR is greatly appreciated.

Author information



Corresponding author

Correspondence to Gregor Reid.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Reid, G., Bruce, A.W. Probiotics to prevent urinary tract infections: the rationale and evidence. World J Urol 24, 28–32 (2006).

Download citation


  • Probiotics
  • Urinary tract infections