Efficacy of Probiotics as Prophylaxis for Urinary Tract Infections in Premenopausal Women: A Systematic Review and Meta-Analysis

Abstract

Introduction: Although antibiotic therapy has been the mainstay of prophylaxis and treatment of urinary tract infections (UTIs), antibacterial resistance has led to increased incidence of infections and healthcare spending in both community-acquired and nosocomial UTIs. This has led to an active exploration of alternative remedies for both the prophylaxis and treatment of UTIs, especially in women with recurrent urinary tract infections. Probiotic supplementation is one novel intervention that has been studied as a prophylactic measure in patients with UTIs. The current systematic review and meta-analysis was conducted to evaluate the efficacy of probiotics for prophylaxis in UTIs in premenopausal women. Methods: Detailed search strategies for each electronic database were developed for PubMed, EMBASE, and Scopus to identify relevant literature published between 2001-2021. RevMan 5.3 statistical software was used to analyze data in studies. The random-effects model was used for pooling the data. The risk of bias and study quality were assessed using Cochrane Collaboration’s tool for assessing risk of bias in included studies. The scope of focus for this review was premenopausal adult women with a history of one or more UTI. The intervention consisted of a probiotic regimen for which the goal was to enhance the defensive microflora of the urogenital tract. Studies comparing a probiotic regimen to a placebo regimen were included. These studies’ primary outcome was the proportion of women with at least one symptomatic bacterial UTI in each group (i.e., UTI recurrence rate) in the 12-month period following probiotic intervention. This study extends the work of researchers who systematically investigated the scientific literature on probiotics in the prevention of urinary tract infections with a particular focus on premenopausal women. Results: After screening, three parallel-group randomized-controlled trials (RCTs) were included. We estimated the overall pooled data of these three studies with a total of 284 participants to have met the predefined inclusion criteria and were therefore included in this review. The results demonstrated that probiotics did not have a significant effect in the prophylaxis of UTIs. (Risk Ratio (RR): 0.59 confidence interval (CI): 0.26, 1.33), Heterogeneity: Chi² = 6.63, df = 2 ( p = 0.04); I² =70%, Test for overall effect: Z = 1.27 ( p = 0.20). Conclusions : Probiotics did not demonstrate a significant benefit in reducing UTI recurrence compared to placebo in premenopausal women. However, more conclusive data is needed to determine the effect that probiotics have on strengthening the urogenital microbial barrier against pathogenic bacteria and protecting against UTI recurrence.

Therapeutic effects of orally administration of viable and inactivated probiotic strains against murine urinary tract infection

“…It should be noted that several clinical studies have provided support for the use of specific “viable probiotics” as a safe and effective intervention in preventing recurrent UTIs [ 38 – 41 ]. However, conflicting reports have emerged that do not endorse the use of probiotics as prophylaxis for UTIs [ 42 ]. The divergence in conclusions among studies may be attributed to the varying efficacy of probiotics, which heavily depends on the strain, dosage, and timing of administration.…”

Young Women’s Attitudes and Behaviors in Treatment and Prevention of UTIs: Are Biomedical Students at an Advantage?

“…However, the results of systematic reviews of published data indicate that probiotics do not have a significant effect on the prophylaxis of UTIs in premenopausal women. Furthermore, it is not clear which interventional variables (i.e., routes of administration or bacterial strains) are the most effective [33].…”

Competitive Inoculation as an Effective Prophylaxis Against Recurrent Urinary Tract Infections: A Systematic Review

“…However, 2 systematic reviews conducted in 2015 and 2021 noted probiotics provided no significant benefit in reducing UTI recurrence compared to placebo. It was concluded that the trials were or poor quality and there was insufficient evidence to support probiotics [30,31]. In another example of competitive inhibition, Ohlemacher et al [32] discovered that enterobacteria secrete escherichelin that inhibits and prevents opportunistic symptomatic infections from Pseudomonas aeroguinosa.…”