Effect of Probiotics on Urinary Tract Infections in Children: A Systematic Review and Meta-Analysis

Abstract

Background: Urinary tract infections (UTIs) are the most prevalent bacterial infections that occur in children worldwide. Objective: This meta-analysis aims to investigate the utility of probiotics as preventive therapy in children with a UTI. Methods: The Web of Science, PubMed, and Scopus were searched for articles that investigated the relationship between probiotic consumption and the risk of UTIs. The quality of the articles was evaluated using the Jadad scale. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Subgroup analyses and sensitivity analyses were also conducted. The Cochran Q test and the statistic I2 were used to evaluate heterogeneity. To determine any potential publication bias, the Egger’s and Begg’s tests were used. Results: In total, eleven studies were selected for systematic review and meta-analysis. Compared to children who did not receive probiotics, the OR of developing or having a recurring urinary tract infection in those who received probiotics was 0.94 (95% CI; 0.88–0.999; p-value=0.046). The Begg's and Egger's tests showed no evidence of publication bias between probiotics and the risk of developing new or recurring urinary tract infections. Conclusion: Based on this systematic review and meta-analysis, probiotics could be an alternative therapy for children who are at risk of developing a UTI. They are non-pharmaceutical options and could be used as natural prophylaxis for UTIs. However, the currently published evidence does not irrefutably confirm that probiotics provide a protective effect against urinary bacterial infections. Therefore, there need to be large-scale randomized clinical trials undertaken to investigate the possible prophylaxis of probiotics.

Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 versus Placebo as Prophylaxis for Recurrence of Urinary Tract Infections in Children

“…Hosseini et al found in a meta-analysis that combining probiotic therapy with antibiotics effectively prevents rUTIs in children [ 41 ]. Emami et al, based on eleven systematic reviews and meta-analyses, found that probiotics may be an alternative natural prophylaxis for UTIs in children [ 20 ]. Hudson et al concluded that Lactobacillus strains seem to be the most effective in prophylaxis recurrent UTIs in pregnant women and children [ 42 ].…”

“…Lately, there has been an increasing interest in alternative methods for preventing UTIs, like immunotherapy, cranberry, and probiotics [ 10 , 11 , 12 , 13 , 14 , 15 ]. Using some probiotics appears to reduce the risk of UTIs [ 16 , 17 , 18 , 19 , 20 ]. Lactobacilli strains were used as prophylaxis for the recurrence of UTIs (rUTIs).…”

“…Some intervention studies have reported whether administering specific Lactobacillus strains can prevent UTIs [ 37 , 38 ]. The most recent research showed diversity in the methodologies employed [ 14 , 16 , 18 , 19 , 20 ].…”

Emerging Non-Antibiotic Options Targeting Uropathogenic Mechanisms for Recurrent Uncomplicated Urinary Tract Infection

“…Therefore, probiotic supplementation could theoretically enhance protective microbe colonization, compete for nutrients, inhibit uropathogen biofilms, and potentially prevent UTIs [ 58 ]. Six meta-analyses and one meta-analysis targeting children were identified [ 84 , 113 , 114 , 115 , 116 , 117 ]; three meta-analyses reported significant positive effects of using probiotics for rUTI prevention compared to placebo in women and children [ 113 , 114 , 115 ], while the other three did not demonstrate a significant benefit in reducing UTI recurrence with probiotics compared to placebo in women [ 63 , 84 , 85 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 ]. Among the included studies, there was a lack of standardization of dose, strain, and frequency, which may impact the quantitative analysis of the outcomes, leading to contradictory results.…”