Uncomplicated Bacterial Communityacquired Urinary Tract Infection in Adults. Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection. Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial Utilization of the Intestinal Tract as a Delivery System for Urogenital Probiotics Treatment of lower urinary tract infection in pregnancy. Randomized clinical trial on antimicrobial prophylaxis for flexible urethrocystoscopy. Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial. Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 to prevent or cure bacterial vaginosis among women with HIV. Antibiotic Treatment to Prevent Urinary Tract Infections after Urodynamic Evaluation
 Probiotics prophylaxis in children with persistent primary vesicoureteral reflux Effectiveness of ciprofloxacin prophylaxis in preventing bacteriuria caused by urodynamic study: a blind, randomized study of 192 patients. Vaginal mucosal immunization for recurrent urinary tract infection: extended phase II clinical trial. Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Prophylaxis of bacteriuria during intermittent catheterization of the acute neurogenic bladder. Efficacy of antibiotic prophylaxis in patients undergoing cystoscopy: a randomized clinical trial Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial.
BACKGROUND Uncomplicated bacterial community-acquired urinary tract infection is among the more common infections in outpatient practice . The resistance level of pathogens has risen markedly . This S3 guideline contains recommendations based on current evidence for the rational use of anti - microbial agents and for the prevention of inappropriate use of certain classes of antibiotics and thus of the result ing drug resistance . The prevention of recurrent urinary tract infection is considered in this guideline for the first time . METHODS The guideline was up date d under the aegis of the German Urological Society ( Deutsche Gesellschaft für Urologie ) . A systematic literature search ( period : 2008 - 2015 ) concerning the diagnosis , treatment , and prevention of uncomplicated urinary tract infections was carried out in the Cochrane Library , MEDLINE , and Embase data bases . R and omized , controlled trials and systemic review s were included . Relevant guidelines were identified in a guideline synopsis . RESULTS Symptom-oriented diagnostic evaluation is highly valued . For the treatment of cystitis , fosfomycin-trometamol , nitrofurantoin , nitroxolin , pivmecillinam and trimethoprim are all equally recommended . Fluorquinolones and cephalosporins are not recommended . Uncomplicated pyelonephritis with a mild to moderate clinical course ought to be treated with oral cefpodoxime , ceftibuten , ciprofloxacin , or levofloxacin . For acute , uncomplicated cystitis , with mild to moderate symptoms , symptomatic treatment alone may be considered instead of antibiotics after discussion of the options with the patient . Mainly non-antibiotic measures are recommended for prophylaxis against recurrent urinary tract infection . CONCLUSION Physicians who treat uncomplicated urinary tract infections should familiarize themselves with the newly revised guideline 's recommendations on the selection and dosage of antibiotic treatment so that they can responsibly evaluate and plan antibiotic treatment for their affected patients Bacterial vaginosis ( BV ) is particularly common in black women , and in Nigeria it is often caused by Mycoplasma , as well as Atopobium , Prevotella and Gardnerella sp. Antimicrobial metronidazole oral therapy is poorly effective in eradicating the condition and restoring the Lactobacillus microbiota in the vagina . In this study , 40 women diagnosed with BV by discharge , fishy odor , sialidase positive test and Nugent Gram stain scoring , were r and omized to receive either two dried capsules containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 each night for 5 days , or 0.75 % metronidazole gel , applied vaginally twice a day ( in the morning and evening ) . Follow-up at day 6 , 15 and 30 showed cure of BV in significantly more probiotic treated subjects ( 16 , 17 and 18/20 , respectively ) compared to metronidazole treatment ( 9 , 9 and 11/20 : P=0.016 at day 6 , P=0.002 at day 15 and P=0.056 at day 30 ) . This is the first report of an effective ( 90 % ) cure of BV using probiotic lactobacilli . Given the correlation between BV and HIV , and the high risk of the latter in Nigeria , intravaginal use of lactobacilli could provide women with a self-use therapy , similar to over-the-counter anti-yeast medication , for treatment of urogenital infections Changes in the indigenous vaginal microflora with uropathogenic bacteria can predispose women to frequently recurring bacterial cystitis . Lactobacilli used as probiotics have played an important role in preventing the colonization of pathogenic bacteria in the vagina . A prospect i ve clinical pilot study was performed to confirm the safety and effectiveness of Lactobacillus vaginal suppositories against the recurrence of bacterial urinary tract infection ( UTI ) . The patients enrolled in the study were instructed to administer vaginal suppositories containing the strain Lactobacillus crispatus GAI 98322 . A significant reduction in the number of recurrences was noted , without any adverse complication ( P=0.0007 ) . The administration of vaginal suppositories containing L. crispatus GAI 98332 seemed to be a safe and promising treatment for the prevention of recurrent UTI Objective To determine the prevalence of bacterial vaginosis in women undergoing first trimester suction termination of pregnancy and to evaluate the efficacy of metronidazole in reducing the risk of post abortal pelvic infection in women with bacterial vaginosis Orally consumed viable bacteria with proposed beneficial health effects , the so-called probiotics , are increasingly used to treat disorders of the gastrointestinal tract . It has been recently suggested that specifically selected lactobacilli could have a therapeutic role in female urogenital tract infections . It has been also suggested that some of these bacteria could be not intravaginally instilled , but also orally delivered . The authors investigate the ability of lactobacilli isolated from the vagina to survive gastrointestinal tract transit , and establish a link between the rate of intestinal survival and vaginal colonization Urinary tract infection ( UTI ) is a common complication of pregnancy . Approximately 20 - -40 % of women with asymptomatic bacteriuria will develop pyelonephritis during pregnancy . All pregnant women , therefore , should have their urine cultured at their first visit to the clinic . In a clinical study comparing single-dose treatment with 3 g fosfomycin trometamol versus a 3-day course of 400 mg ceftibuten orally , the inclusion criteria were acute symptomatic lower UTI ( acute cystitis ) , significant bacteriuria ( > or = 10(3 ) CFU/ml ) , pyuria and confirmed pregnancy . Excluded were patients with asymptomatic bacteriuria or acute pyelonephritis . Predisposing factors comprised a history of recurrent UTI , diabetes mellitus , analgesic nephropathy , hyperuricaemia or Fanconi 's syndrome . Escherichia coli was the most frequently isolated pathogen in both groups . Therapeutic success ( clinical cure and bacteriological eradication of uropathogens ) was achieved in 95.2 % of the patients treated with fosfomycin-trometamol versus 90.0 % of those treated with ceftibuten ( P , non-significant ) . The treatment of acute cystitis in pregnant women using a single-dose of fosfomycin trometamol was equally effective as the 3-day course of oral ceftibuten . Both regimens were well tolerated with only minor adverse effects . Long-term chemoprophylaxis should be suggested in patients with recurrent UTI or following acute pyelonephritis during pregnancy OBJECTIVES One of the main drawbacks of flexible urethrocystoscopy is the risk of urinary tract infection ( UTI ) . In order to reduce this risk , antimicrobial prophylaxis has been considered , however there is not a unanimous view regarding indications , dosage , type of antibiotic , and so on . To clarify this uncertainty , we practice d a pilot and experimental study aim ed at assessing the effectiveness of chemoprophylaxis with 3 grams of fosfomycin trometamol in the prevention of UTI after urethrocystoscopy . METHODS Sixty patients were entered into a pilot r and omized clinical trial between March and August 2011 . Thirty patients were assigned to a control group without receiving any antibiotic dose , and the intervention group ( 30 patients ) received 3 g fosfomycin trometamol . Ten days later urine culture and sediment analysis were performed in all patients . Significant bacteriuria was considered from > 105 CFU /ml . One month later a telephone survey was developed to assess urinary symptoms , and assistance to the family doctor . We estimated the cumulative incidence of bacteriuria , pyuria and microhematuria in both groups , and we compared the results using a strategy of analysis per protocol and intention to treat . RESULTS The incidence of bacteriuria , pyuria and microhematuria in the control group was 10 % , 23.3 % and 26.7 % respectively and in the intervention groups the values differed depending on the type of analysis . Considering only the 27 patients ( per protocol analysis ) , the incidence would be 11.1 % , 37.0 % and 29.6 % respectively . If we include the three patients who did not completed the study ( per intention to treat analysis ) and considering their results as negative , the results were 10 % , 33.3 % and 26.7 % respectively . Finally , in the case the three cultures not performed in this group had produced a positive result , the impact would have been 20.0 % , 43.3 % and 36.7 % . In any of the three cases , the differences with the control group were not statistically significant . CONCLUSIONS In a selected population and with appropriate aseptic measures , antibiotic chemoprophylaxis does not appear to show a clinical ly relevant reduction in the incidence of UTI in patients undergoing flexible urethrocystoscopy This study enrolled 125 premenopausal women diagnosed with bacterial vaginosis ( BV ) by presence of vaginal irritation , discharge and ' fishy ' odor , and Nugent criteria and detection of sialidase enzyme . The subjects were treated with oral metronidazole ( 500 mg ) twice daily from days 1 to 7 , and r and omized to receive oral Lactobacillus rhamnosus GR-1 ( 1 x 10(9 ) ) and Lactobacillus reuteri RC-14 ( 1 x 10(9 ) ) or placebo twice daily from days 1 to 30 . Primary outcome was cure of BV as determined by normal Nugent score , negative sialidase test and no symptoms or signs of BV at day 30 . A total of 106 subjects returned for 30-day follow-up , of which 88 % were cured in the antibiotic/probiotic group compared to 40 % in the antibiotic/placebo group ( p<0.001 ) . Of the remaining subjects , 30 % subjects in the placebo group and none in the probiotic group had BV , while 30 % in the placebo and 12 % in the probiotic group fell into the intermediate category based upon Nugent score , sialidase result and clinical findings . High counts of Lactobacillus sp. ( > 10(5 ) CFU/ml ) were recovered from the vagina of 96 % probiotic-treated subjects compared to 53 % controls at day 30 . In summary , this study showed efficacious use of lactobacilli and antibiotic in the eradication of BV in black African women OBJECTIVE To assess , among women with HIV , whether long-term oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 supplementation can prevent bacterial vaginosis ( BV ) and enhance the cure rate of metronidazole  among those with BV . METHODS A r and omized , double-blind , placebo-controlled trial conducted among 65 HIV-infected women with an aberrant microbiota ( Nugent score 4 - 10 ) who were r and omized to receive daily probiotics or placebo for 6 months . Those with BV ( Nugent score 7 - 10 ) additionally received metronidazole for 10 days ( 400 mg twice daily ) . RESULTS We did not find an enhanced cure rate of BV among women with HIV treated with adjuvant probiotics to metronidazole treatment . Among women with an intermediate vaginal flora , probiotics tended to increase the probability of a normal vaginal flora ( odds ratio 2.4 ; P=0.1 ) and significantly increased the probability of a beneficial vaginal pH ( odds ratio 3.8 ; P=0.02 ) at follow-up . CONCLUSION Supplementation of probiotic L. rhamnosus GR-1 and L. reuteri RC-14 did not enhance the cure of BV among women living with HIV , but may prevent the condition among this population . TRIAL REGISTRATION NCT00536848 Abstract : The aim of the study was to determine the efficacy of cotrimoxazole administration after urodynamic testing to prevent urinary tract infections . In a single-blind prospect i ve r and omized study 94 women who attended for urodynamic evaluation were included . After multichannel urodynamic testing , including two catheterizations , the women received a single dose of cotrimoxazole or placebo . A clean-catch urine specimen was tested for infection after 1 week . Seventy women returned a urine specimen after 1 week : 2/37 ( 5.4 % ) in the treatment and 2/33 ( 6.1 % ) in the placebo group had acquired a new urinary tract infection after urodynamics . One major and one minor adverse reaction to cotrimoxazole were reported . The power of the sample size was unfortunately too small to draw conclusions as to the efficacy of prophylaxis 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 prospect i ve r and omized 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 r and omly 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 OBJECTIVES To determine the efficacy of prophylactic ciprofloxacin in preventing  urinary tract infections caused by urodynamic study ( UDS ) . METHODS A total of 210 patients presenting for UDS during a 16-month period were offered enrollment in the study . A clean-catch midstream urine sample was taken 24 hours before and 48 to 72 hours after the procedure and after microscopic examination and culture were done . All patients underwent a st and ard UDS . The 192 patients who had sterile urine before intervention were included in the study . R and omly , 98 of the 192 patients were orally given 500 mg of ciprofloxacin 1 hour before the urodynamic intervention and 94 were not given anything . The patients who were found to have significant bacteriuria after UDS were followed up and treated properly . RESULTS Eighteen patients ( 8.6 % ) who had significant bacteriuria in the urine culture before UDS were excluded from the study . The rate of significant bacteriuria in the urine culture after UDS was 7.3 % overall , 1 % in the prophylaxis group , and 14 % in the controls , a significant difference ( P = 0.002 ) . The most common uropathogen was Escherichia coli ( 57 % ) . Three independent risk factors were identified : not giving antibiotic prophylaxis before UDS ; antibiotic use in the preceding month ; and the presence of pyuria before UDS . CONCLUSIONS Urinary tract infections after UDS decreased from 14 % to 1 % with a single dose of ciprofloxacin 500 mg orally before UDS . We recommend antibiotic prophylaxis for patients undergoing a UDS Many women remain susceptible to ascending urinary tract infections ( UTIs ) despite the absence of a demonstrable anatomic abnormality [ 1 ] . Repeated treatment with antibiotics is often necessary for these women but may lead to adverse reactions and infection with antibiotic-resistant organisms [ 2 ] . On the basis of concepts of mucosal immunity in the genitourinary tract [ 3 - 5 ] , we have been working to develop an effective mucosally applied vaginal immunogen to help prevent ascending UTIs . After a trial in nonhuman primates , we carried out and reported two previous clinical trials in susceptible women [ 6 - 8 ] . We are now reporting on a clinical trial to extend the time period of protection through use of the same multivalent vaginal immunogen and through immunogen boosts given at 4week intervals BACKGROUND Urinary tract infections ( UTIs ) are common among women and frequently recur . Depletion of vaginal lactobacilli is associated with UTI risk , which suggests that repletion may be beneficial . We conducted a double-blind placebo-controlled trial of a Lactobacillus crispatus intravaginal suppository probiotic ( Lactin-V ; Osel ) for prevention of recurrent UTI in premenopausal women . METHODS One hundred young women with a history of recurrent UTI received antimicrobials for acute UTI and then were r and omized to receive either Lactin-V or placebo daily for 5 d , then once weekly for 10 weeks . Participants were followed up at 1 week and 10 weeks after intervention and for UTIs ; urine sample s for culture and vaginal swabs for real-time quantitative 16S ribosomal RNA gene polymerase chain reaction for L. crispatus were collected . RESULTS Recurrent UTI occurred in 7/48 15 % of women receiving Lactin-V compared with 13/48 27 % of women receiving placebo ( relative risk [ RR ] , .5 ; 95 % confidence interval , .2 - 1.2 ) . High-level vaginal colonization with L. crispatus ( ≥10(6 ) 16S RNA gene copies per swab ) throughout follow-up was associated with a significant reduction in recurrent UTI only for Lactin-V ( RR for Lactin-V , .07 ; RR for placebo , 1.1 ; P < .01 ) . CONCLUSIONS Lactin-V after treatment for cystitis is associated with a reduction in recurrent UTI . Larger efficacy trials of this novel preventive method for recurrent UTI are warranted . CLINICAL TRIALS REGISTRATION . NCT00305227 A r and omized prospect i ve study of bacteriuria control during early intermittent bladder catheterization was performed on a spinal cord injury service . The 64 male subjects underwent 16,620 catheterizations and had 83 significant episodes of infection . The infection rates among various groups were compared : 1 )  control patients  , 2 ) patients treated with intravesical neomycin/polymyxin-B , 3 ) patients given low dose daily macrocrystals of nitrofurantoin and 4 ) patients given intravesical treatment and oral nitrofurantoin . There was significant reduction in infection rates when oral and intravesical antibiotics were used Objective To establish the efficacy of antibiotic prophylaxis prior to cystoscopy in out patients in decreasing the incidence of post-procedure urinary tract infection . Study design and setting A r and omized clinical trial in patients ( men and women ) older than 18 who underwent cystoscopy for any non-urgent indication . The intervention was Levofloxacin 500 mg single dose , and the control was placebo 500 mg single dose made with similar characteristics . The primary outcome was urinary tract infection ( UTI ) measured 3–10 days after the procedure . It was performed as per protocol analysis . Results Hundred and thirty-eight patients in each study arm completed the trial . The incidence of UTI in the intervention group was 0.7 % and in the placebo group was 3 % ( p = 0.17 ) , and no significant differences were found . The incidence of asymptomatic bacteriuria in the intervention group was 5.8 % and in the control group was 14.5 % ( p = 0.01 ) . Conclusions No significant differences were found in the use of prophylactic antibiotic compared to placebo to reduce the incidence of UTI in patients who undergo cystoscopy as an outpatient procedure with sterile urine demonstrated by urine culture Bacterial vaginosis ( BV ) is the most prevalent vaginal infection worldwide and is characterized by depletion of the indigenous lactobacilli . Antimicrobial therapy is often ineffective . We hypothesized that probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 might provide an adjunct to antimicrobial treatment and improve cure rates .  Sixty-four Brazilian women diagnosed with BV were r and omly assigned to receive a single dose of tinidazole ( 2 g ) supplemented with either 2 placebo capsules or 2 capsules containing L. rhamnosus GR-1 and L. reuteri RC-14 every morning for the following 4 weeks . At the end of treatment ( day 28 ) , the probiotic group had a significantly higher cure rate of BV ( 87.5 % ) than the placebo group ( 50.0 % ) ( p = 0.001 ) . In addition , according to the Gram-stain Nugent score , more women were assessed with " normal " vaginal microbiota in the probiotic group ( 75.0 % vs. 34.4 % in the placebo group ; p = 0.011 ) . This study shows that probiotic lactobacilli can provide benefits to women being treated with antibiotics for an infectious condition
Overall , lactobacilli were beneficial for the treatment of patients with bacterial vaginosis .
No clear benefit was seen for c and idiasis or urinary tract infection .
In conclusion , the use of certain lactobacillus strains such as L. rhamnosus GR-1 and L. reuteri for prevention and treatment of recurrent urogenital infection is promising , especially for recurrent bacterial vaginosis .
Abstract Probiotics are increasingly being used to treat and prevent urogenital infections .
However , a critical assessment of their efficacy in major urogenital infections is lacking .
We report the results of a systematic review to determine the efficacy of probiotics for prevention or treatment of three major urogenital infections : bacterial vaginosis , vulvovaginal c and idiasis , and urinary tract infection .