Probiotics for Prevention of Recurrent Urinary Tract Infections in Women

A Review of the Evidence from Microbiological and Clinical Studies


Recurrent urinary tract infections (UTIs) afflict a great number of women around the world. The use of probiotics, especially lactobacilli, has been considered for the prevention of UTIs. Since lactobacilli dominate the urogenital flora of healthy premenopausal women, it has been suggested that restoration of the urogenital flora, which is dominated by uropathogens, with lactobacilli may protect against UTIs. This review is based on a search of PubMed for relevant articles. Many in vitro studies, animal experiments, microbiological studies in healthy women, and clinical trials in women with UTIs have been carried out to assess the effectiveness and safety of probiotics for prophylaxis against uropathogens. Most of them had encouraging findings for some specific strains of lactobacilli. Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 (previously called L. fermentum RC-14) seemed to be the most effective among the studied lactobacilli for the prevention of UTIs. L. casei shirota and L. crispatus CTV-05 have also shown efficacy in some studies. L. rhamnosus GG did not appear to be quite as effective in the prevention of UTIs. The evidence from the available studies suggests that probiotics can be beneficial for preventing recurrent UTIs in women; they also have a good safety profile. However, further research is needed to confirm these results before the widespread use of probiotics for this indication can be recommended.

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  1. 1.

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  1. 1.

    Foxman B, Barlow R, D’Arcy H, et al. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol 2000; 10: 509–15

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Reid G, Jass J, Sebulsky T, et al. Potential uses of probiotics in clinical practice. Clin Microbiol Rev 2003; 16: 658–72

    PubMed  Article  Google Scholar 

  3. 3.

    Senok A, Ismaeel A, Botta G. Probiotics: facts and myths. Clin Microbiol Infect Dis 2005; 11(12): 958–66

    Article  CAS  Google Scholar 

  4. 4.

    De Vrese M, Schrezenmeir J. Probiotics and non-intestinal infectious conditions. Br J Nutr 2002; 88: S59–66

    Article  Google Scholar 

  5. 5.

    Antonio M, Hawes S, Hillier S. The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonised by these species. J Infect Dis 1999; 180: 1950–6

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Zhou X, Bent SJ. Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods. Microbiology 2004; 150: 2565–73

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Burton J, Cardieux P, Reid G. Improved understanding of the bacterial vaginal microbiota of women before and after probiotic instillation. Appl Environ Microbiol 2003; 69: 97–101

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Bruce AW, Chadwick P, Hassan A, et al. Recurrent urethritis in women. CMAJ 1973 Apr; 108(8): 973–6

    CAS  Google Scholar 

  9. 9.

    Stamm W, Raz R. Factors contributing to susceptibility of postmenopausal women to recurrent urinary tract infections. Clin Infect Dis 1999; 28: 723–5

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Keane F, Ison C, Taylor-Robinson D. A longitudinal study of the vaginal flora over a menstrual cycle. Int J STD AIDS 1997; 8: 489–94

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Reid G, Sobel J. Bacterial adherence in the pathogenesis of urinary tract infection: a review. Rev Infect Dis 1987; 9: 470–87

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Hawthorn LA, Reid G. Exclusion of uropathogen adhesion to polymer surfaces by Lactobacillus acidophilus. J Biomed Mater Res 1990; 24(1): 39–46

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Velraeds MM, van de Belt-Gritter B, van der Mei HC, et al. Interference in initial adhesion of uropathogenic bacteria and yeasts to silicone rubber by a Lactobacillus acidophilus biosurfactant. J Med Microbiol 1998; 47(12): 1081–5

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Heineman C, van Hylckama Vlieg JE. Purification and characterization of a surface-binding protein from Lactobacillus fermentum RC-14 that inhibit adhesion of Enterococcus faecalis 1131. FEMS Microbiol Lett 2000; 190(1): 177–80

    Article  Google Scholar 

  15. 15.

    Osset J, Bartolome RM, Garcia E, et al. Assessment of the capacity of Lactobacillus to inhibit the growth of uropathogens and block their adhesion to vaginal epithelial cells. J Infect Dis 2001; 183(3): 485–91

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Reid G, Cook RL, Bruce AW. Examination of strains of lactobacilli for properties that may influence bacterial interference in the urinary tract. J Urol 1987; 138(2): 330–5

    PubMed  CAS  Google Scholar 

  17. 17.

    McGroaty JA, Reid G. Detection of lactobacillus substance that inhibits Escherichia Coli. Can J Microbiol 1998; 34(8): 974–8

    Article  Google Scholar 

  18. 18.

    Reid G, Chan RC, Bruce AW, et al. Prevention of urinary tract infection in rats with an indigenous Lactobacillus casei strain. Infect Immun 1985; 49(2): 320–4

    PubMed  CAS  Google Scholar 

  19. 19.

    Herthelius M, Gorbach SL. Elimination of vaginal colonisation with Escherichia coli by administration of indigenous flora. Infect Immun 1989; 57(8): 2447–51

    PubMed  CAS  Google Scholar 

  20. 20.

    Silva de Ruiz C, Lopez de Bocanera ME, Nader de Macias ME, et al. Effect of lactobacilli and antibiotics on E. coli urinary infections in mice. Biol Pharm Bull 1996; 19(1): 88–93

    Google Scholar 

  21. 21.

    Asahara T, Nomoto K, Watanuki M, et al. Antimicrobial activity of intraurethrally administered probiotic Lactobacillus casei in a murine model of Escherichia coli urinary tract infection. Antimicrob Agents Chemother 2001 Jun; 45(6): 1751–60

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Patton DL, Cosgrove Sweeney YT, Antonio MA, et al. Lactobacillus crispatus capsules: single-use safety study in the Macaca nemestrina model. Sex Transm Dis 2003 Jul; 30(7): 568–70

    PubMed  Article  Google Scholar 

  23. 23.

    Colodner R, Edelstein H, Chazan B, et al. Vaginal colonisation by orally administered Lactobacillus rhamnosus GG. Isr Med Assoc J 2003; 5(11): 767–9

    PubMed  Google Scholar 

  24. 24.

    Cardieux P, Burton J, Gardiner G, et al. Lactobacillus strains and vaginal ecology. JAMA 2002; 287: 1940–1

    Article  Google Scholar 

  25. 25.

    Reid G, Beuerman D, Heinemann C, et al. Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS Immunol Med Microbiol 2001; 32: 37–41

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Reid G, Charbonneau D, Erb J, et al. 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 2003; 35: 131–4

    CAS  Google Scholar 

  27. 27.

    Morelli L, Zonenenschain D, Del Piano M, et al. Utilization of the intestinal tract as a delivery system for urogenital probiotics. J Clin Gastroenterol 2004; 38: S107–10

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Hoesl CE, Altwein JE. The probiotic approach: an alternative treatment option in urology. Eur Urol 2005; 47: 288–96

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Newman D. Treatment of cystitis by intravesical injections of lactic bacillus cultures. Lancet 1915; II: 330

    Article  Google Scholar 

  30. 30.

    Hagberg L, Bruce AW, Reid G, et al. Colonisation 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, Svanborg Eden C, editors. Host-parasite interactions in urinary tract infections. Chicago (IL): University of Chicago Press, 1989: 194–7

    Google Scholar 

  31. 31.

    Bruce AW, Reid G. Intravaginal instillation of lactobacilli for prevention of recurrent urinary tract infections. Can J Microbiol 1988; 34: 339–43

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Reid G, Bruce AW, Taylor M. Influence of 3-day antimicrobial therapy and Lactobacillus suppositories on recurrence of urinary tract infection. Clin Ther 1992; 14: 11–6

    PubMed  CAS  Google Scholar 

  33. 33.

    Reid G, Millsap K, Bruce A. Implantation of Lactobacillus casei var rhamnosus into vagina. Lancet 1994; 344: 1229

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Reid G, Bruce AW, Taylor M. Instillation of Lactobacillus and stimulation of indigenous organisms to prevent recurrence of urinary tract infections. Microecol Ther 1995; 23: 32–45

    Google Scholar 

  35. 35.

    Baerheim A, Larsen E, Digranes A. Vaginal application of lactobacilli in the prophylaxis of recurrent urinary tract infection in women. Scand J Prim Health Care 1994; 12: 239–43

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Tomoda T, Nakano Y, Kageyama T. Intestinal Candida overgrowth and Candida infection in patients with leukemia: effect of Bifidobacterium administration. Bifidobacteria Microflora 1988; 7: 71–4

    Google Scholar 

  37. 37.

    Kontiokari T, Sundqvist K, Nuutinen M, et al. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 2001; 322: 1–5

    Article  Google Scholar 

  38. 38.

    Kontiokari T, Laitinen J, Jarvi L, et al. Dietary factors protecting women from urinary tract infection. J Clin Nutr 2003; 77: 600–4

    CAS  Google Scholar 

  39. 39.

    Reid G, Bruce A, Fraser N, et al. Oral probiotics can resolve urogenital infections. FEMS Immunol Med Microbiol 2001; 30: 49–52

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Husni R, Gordon S, Washington J, et al. Lactobacillus bacteremia and endocarditis: review of 45 cases. Clin Infect Dis 1997; 25: 1048–55

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Borriello S, Hammes W, Holzapfel W, et al. Safety of probiotics that contain lactobacilli or bifidobacteria. Clin Infect Dis 2003; 36: 775–80

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Gasser F. Safety of lactic acid bacteria and their occurrence in human clinical infections. Bull Inst Pasteur 1994; 92: 45–67

    Google Scholar 

  43. 43.

    Rautio M, Jousimies-Somer H, Kauma H, et al. Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG. Clin Infect Dis 1999; 28: 1159–60

    Article  CAS  Google Scholar 

  44. 44.

    Mackay A, Taylor M, Kibbler C, et al. Lactobacillus endocarditis caused by a probiotic organism. Clin Microbiol Infect 1999; 5: 290–2

    PubMed  Article  Google Scholar 

  45. 45.

    Adams M, Marteau P. On the safety of lactic acid bacteria from food. Int J Food Microbiol 1995; 27: 263–4

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Andreu A. Lactobacillus as a probiotic for preventing urogenital infections. Rev Med Microbiol 2004 Jan; 15(1): 1–6

    Article  Google Scholar 

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Correspondence to Dr Matthew E. Falagas.

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Falagas, M.E., Betsi, G.I., Tokas, T. et al. Probiotics for Prevention of Recurrent Urinary Tract Infections in Women. Drugs 66, 1253–1261 (2006).

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  • Lactobacillus
  • Bacterial Vaginosis
  • Recurrent Urinary Tract Infection
  • Vaginal Flora
  • Vaginal Fluid