Utilization of the Intestinal Tract as a Delivery System for Urogenital Probiotics Prevention of subsequent urinary tract infections in women by the use of anti-adherence antimicrobial agents: a double-blind comparison of enoxacin with co-trimoxazole. Treatment of bacterial infections of the female urinary tract by immunization of the patients. Treatment of lower urinary tract infection in pregnancy. Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double-blind randomized controlled trial. The prophylactic use of probiotics in the prevention of radiation therapy-induced diarrhea. Antecedent antimicrobial use increases the risk of uncomplicated cystitis in young women. Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Probiotics and prebiotics in gastrointestinal disorders A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection. Isolation of fluoroquinolone-resistant rectal Escherichia coli after treatment of acute uncomplicated cystitis. Effectiveness of probiotic therapy for the prevention of relapse in patients with inactive ulcerative colitis. Uncomplicated Bacterial Communityacquired Urinary Tract Infection in Adults. Randomized Clinical Trial of Antibiotic Therapy for Antenatal Pyelonephritis Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Daily probiotic's (Lactobacillus casei Shirota) reduction of infection incidence in athletes. Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It?
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 A prospect i ve , double-blinded crossover study was carried out to test whether a brief course of antibiotic therapy could eliminate bacteria adherent to uroepithelial cells and thus prolong the interval between urinary tract infections ( UTIs ) .  Thirty-two women with frequent Gram-negative urinary tract infections were r and omized to receive either co-trimoxazole or enoxacin twice a day for 10 days to treat their UTI . Their urines were collected for 30 days after the onset of their UTI and quantitatively analyzed for bacteria , antibiotics , and bacteria adherent to uroepithelial cells ( UECs ) . A subsequent infection caused the patient to be treated with the alternative antibiotic . A third infection terminated the study . Both regimens were indistinguishable in the rate of elimination of bacteria and in their inhibition of bacterial adherence to UECs for up to five days after stopping treatment . The interval between infections was inversely correlated with the number of adherent bacteria per UEC 30 days after the onset of the first UTI . Both regimens were equally effective in preventing subsequent UTI and the effect of 10 days therapy on the inhibition of bacterial adherence to UEC 's did not extend beyond five days after stopping treatment In an open comparative study 400 patients with urinary tract infections were r and omly allocated to two treatment groups . In 202 patients an immune stimulation against uropathogenic bacteria was produced with a new preparation , SolcoUrovac , and only in exceptional cases with pronounced symptomatology was antibiotic therapy given , while in the control group ( n = 198 ) all patients were treated with nitrofurantoin or with another appropriate antibiotic , according to the antibiogram . In the subsequent 12-month observation period 28 infections occurred in 23 patients of the immune-stimulated group and 84 in 47 patients of the control group . This difference is statistically significant ( p less than or equal to 0.001 ) . The preventive effect of the SolcoUrovac therapy was particularly impressive in patients with recurrent urinary tract infections . Thirty-two patients from each group with similar case histories , as matched pairs , were evaluated separately . The relapse rate in the 12-month observation period amounted to 2 re-infections in the group treated with immunotherapy and to 29 in the control group . All side-effects were recorded . No adverse effects were observed in pregnant women or in their offspring 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 BACKGROUND The optimal duration of antibiotic therapy in older patients with uncomplicated urinary tract infection ( UTI ) is still a matter of debate . The aim of this r and omized controlled double-blind noninferiority trial was to compare the efficacy and safety of 3-day and 7-day courses of oral ciprofloxacin for uncomplicated symptomatic UTI in older women . METHODS A total of 183 women at least 65 years of age with acute uncomplicated UTI were recruited from ambulatory clinics and hospital acute care units . Patients with pyelonephritis , contraindications to fluoroquinolones , recent use of antibiotics , urinary tract abnormalities and diabetes mellitus were excluded . Women were r and omly assigned to receive either ciprofloxacin 250 mg twice daily orally for 3 days followed by placebo for 4 days ( the 3-day group , 93 patients ) or ciprofloxacin 250 mg twice daily orally for 7 days ( the 7-day group , 90 patients ) . Bacterial eradication , clinical improvement and occurrence of adverse events were determined 2 days after completion of treatment , and occurrence of reinfection or relapse were determined 6 weeks after completion of treatment . Bacterial eradication and relapse were determined by urine culture . Double-blind procedures were maintained throughout data collection . RESULTS The proportion of patients with bacterial eradication at 2 days after treatment was 98 % ( 91/93 ) in the 3-day group and 93 % ( 83/89 ) in the 7-day group ( p = 0.16 ) . The frequency of adverse events , including drowsiness , headache , nausea or vomiting , and loss of appetite , was significantly lower in the 3-day group . INTERPRETATION These results suggest that a 3-day course of antibiotic therapy is not inferior to a 7-day course for treatment of uncomplicated symptomatic UTI in older women , and that the shorter course is better tolerated Cancer treatment regimens that include radiation therapy ( RT ) to the abdominal region for cervical , ovarian , prostate , sigmoid , or colorectal cancer potentially disturb the colonization resistance of the indigenous gut flora , causing RT-induced diarrhea , enteritis , and colitis in more than 80 % of patients with cancer . One approach for the prevention of RT-induced diarrhea is the use of probiotics . R and omized clinical trials have demonstrated efficacy of probiotic preparations VSL # 3 and Lactobacillus casei DN-114 001 in decreasing the incidence and grade of RT-induced diarrhea . Oncology nurses and advanced practice clinicians are in a position to interpret research findings related to RT-induced diarrhea , enteritis , and colitis and to apply evidence -based practice principles in patients with cancer receiving RT to promote positive outcomes To examine whether antecedent antimicrobial use influenced subsequent relative risk of urinary tract infection ( UTI ) in premenopausal women , data were analyzed from two cohorts of women observed prospect ively for 6 months to determine risk factors for UTI . Using a Cox proportional hazards model to adjust for covariates , we found that 326 women in a University cohort and 425 women in a health-maintenance organization cohort were at increased risks for UTI ( 2.57 [ 95 % confidence interval ( CI ) , 1.24 - 5.32 ] and 5.83 [ 95 % CI , 3.17 - 10.70 ] , respectively ) if antimicrobials had been taken during the previous 15 - 28 days but not during the previous 3 , 7 , or 14 days . The increased risks were noted both for women whose antimicrobial use was for treatment of a previous UTI and for women who received antimicrobials for other illnesses . These results suggest that recent antimicrobial use increases a woman 's risk of UTI , perhaps by altering the indigenous urogenital flora and predisposing to vaginal colonization with uropathogens 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 Purpose of review This review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect . Recent findings The demonstration that immune and epithelial cells can discriminate between different microbial species has extended the known mechanism(s ) of action of probiotics beyond simple barrier and antimicrobial effects . It has also confirmed that probiotic bacteria modulate mucosal and systemic immune activity and epithelial function . The progressive unraveling of these mechanisms of action has led to new credence for the use of probiotics and prebiotics in clinical medicine . Level I evidence now exists for the therapeutic use of probiotics in infectious diarrhea in children , recurrent Clostridium difficile – induced infections and postoperative pouchitis . Level II evidence is emerging for the use of probiotics in other gastrointestinal infections , prevention of postoperative bacterial translocation , irritable bowel syndrome , and in both ulcerative colitis and Crohn disease . Nevertheless , one consistent feature has emerged over the past year : Not all probiotic bacteria have similar therapeutic effects . Future clinical trials will need to incorporate this fact into trial planning and design . Summary The use of probiotics and prebiotics as therapeutic agents for gastrointestinal disorders is rapidly moving into the “ mainstream . ” Mechanisms of action explain the therapeutic effects and r and omized ; controlled trials provide the necessary evidence for their incorporation into the therapeutic armamentarium 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 OBJECTIVES Given increasing rates of co-trimoxazole resistance among uropathogens causing acute uncomplicated cystitis , fluoroquinolones , nitrofurantoin and fosfomycin are often considered as alternative empirical therapy . The choice between these drugs should depend in part on whether they are associated with the isolation of drug-resistant microbial flora . We conducted a r and omized treatment trial to assess the effects of ciprofloxacin , nitrofurantoin and fosfomycin on the rectal microbial flora of women with acute uncomplicated cystitis , including isolation of fluoroquinolone-resistant strains . METHODS Pre-menopausal women presenting with acute uncomplicated cystitis were r and omized to treatment with 3 days of ciprofloxacin , 7 days of nitrofurantoin , or a single dose of fosfomycin . Women were followed for 1 month for evaluation of clinical and microbiological responses as well as for isolation of resistant rectal E. coli . RESULTS Sixty-two women ( 25 ciprofloxacin , 17 nitrofurantoin , 20 fosfomycin ) were enrolled and eligible for analysis . All three regimens were well tolerated and result ed in > 90 % clinical and bacteriological cure . The prevalence of rectal E. coli was markedly decreased by ciprofloxacin and fosfomycin , but not by nitrofurantoin . One woman treated with ciprofloxacin had emergence of two ciprofloxacin-resistant rectal E. coli strains within 10 days of completing therapy . No emergence of resistance was observed in the other two treatment groups . CONCLUSIONS This study demonstrates that fluoroquinolone-resistant E. coli remain infrequent in the rectal flora of women with uncomplicated cystitis in Seattle . However , a 3 day course of a fluoroquinolone for treatment of uncomplicated cystitis was followed by isolation of fluoroquinolone-resistant rectal E. coli in one patient AIM To evaluate the effectiveness of probiotic therapy for suppressing relapse in patients with inactive ulcerative colitis ( UC ) . METHODS Bio-Three tablets , each containing 2 mg of lactomin ( Streptococcus faecalis T-110 ) , 10 mg of Clostridium butyricum TO-A , and 10 mg of Bacillus mesentericus TO-A , were used as probiotic therapy .  Sixty out patients with UC in remission were r and omly assigned to receive 9 Bio-Three tablets/day ( Bio-Three group ) or 9 placebo tablets/day ( placebo group ) for 12 mo in addition to their ongoing medications . Clinical symptoms were evaluated monthly or on the exacerbation of symptoms or need for additional medication . Fecal sample s were collected to analyze bacterial DNA at baseline and 3-mo intervals . Terminal restriction fragment length polymorphism and cluster analyses were done to examine bacterial components of the fecal microflora . RESULTS Forty-six patients , 23 in each group , completed the study , and 14 were excluded . The relapse rates in the Bio-Three and placebo groups were respectively 0.0 % vs 17.4 % at 3 mo ( P = 0.036 ) , 8.7 % vs 26.1 % at 6 mo ( P = 0.119 ) , and 21.7 % vs 34.8 % ( P = 0.326 ) at 9 mo . At 12 mo , the remission rate was 69.5 % in the Bio-Three group and 56.6 % in the placebo group ( P = 0.248 ) . On cluster analysis of fecal flora , 7 patients belonged to cluster I , 32 to cluster II , and 7 to cluster III . CONCLUSION Probiotics may be effective for maintaining clinical remission in patients with quiescent UC , especially those who belong to cluster I on fecal bacterial analysis 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 Objective : The aim of this study was to prospect ively evaluate the efficacy of a therapeutic course of intravenous antibiotics followed by oral antibiotics vs. intravenous antibiotics alone to prevent recurrent urinary tract infection . Methods : Pyelonephritis was documented by strict criteria in 67 pregnant women who were then treated with appropriate intravenous antibiotics until afebrile and asymptomatic for 48 h. Women were then r and omized to completion of a 10-day course of oral nitrofurantoin 100 mg qid or no further antibiotic therapy .  Urine cultures ( UC ) were obtained 2 and 6 weeks after discharge , and at delivery . A positive UC or readmission for pyelonephritis was considered endpoints for participation in the study . Antibiotic suppression was not used . Results : Readmission for pyelonephritis prior to the 2-week follow-up visit occurred in 2/36 ( 5.6 % ) women r and omized to the oral therapy group compared to 4/31 ( 12.9 % ) in the no oral treatment group ( P = 0.29 ) . At the 2-week follow-up visit , 6/31 ( 19.4 % ) women had a positive UC in the oral therapy compared to 8/26 ( 30.1 % ) in the no oral treatment group but this difference was not statistically significant ( P = 0.31 ) . Conclusions : Completion of 10 days of antibiotic therapy with oral medication does not significantly reduce the risk of recurrent pyelonephritis immediately post-parenteral treatment . Women in the no oral treatment group had a non-significant increase in positive UC at the 2-week follow-up visit . The high rates of recurrent urinary tract infection during pregnancy in both groups underscore the need for regular UC and for the possible role of oral antibiotic suppression 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 The purpose of this study was to examine the effects of a probiotic supplement during 4 mo of winter training in men and women engaged in endurance-based physical activities on incidence of  upper respiratory-tract infections ( URTIs ) and immune markers .  Eighty-four highly active individuals were r and omized to probiotic ( n = 42 ) or placebo ( n = 42 ) groups and , under double-blind procedures , received probiotic ( PRO : Lactobacillus casei Shirota [ LcS ] ) or placebo ( PLA ) daily for 16 wk . Resting blood and saliva sample s were collected at baseline and after 8 and 16 wk . Weekly training and illness logs were kept . Fifty-eight subjects completed the study ( n = 32 PRO , n = 26 PLA ) . The proportion of subjects on PLA who experienced 1 or more weeks with URTI symptoms was 36 % higher than those on PRO ( PLA 0.90 , PRO 0.66 ; p = .021 ) . The number of URTI episodes was significantly higher ( p < .01 ) in the PLA group ( 2.1 ± 1.2 ) than in the PRO group ( 1.2 ± 1.0 ) . Severity and duration of symptoms were not significantly different between treatments . Saliva IgA concentration was higher on PRO than PLA , significant treatment effect F(1 , 54 ) = 5.1 , p = .03 ; this difference was not evident at baseline but was significant after 8 and 16 wk of supplementation . Regular ingestion of LcS appears to be beneficial in reducing the frequency of URTI  in an athletic cohort , which may be related to better maintenance of saliva IgA levels during a winter period of training and competition Background / Aims Despite numerous r and omized clinical trials and meta-analyses , there is no increased evidence for the efficacy of  probiotics  in the treatment of irritable bowel syndrome ( IBS ) . We review this evidence , identify and analyse the reasons for this lack of evidence and propose method ological improvements for future studies . Methods Based on a literature search , we identified 56 papers that matched the purpose of our analyses . Twenty-seven studies used multi-species bacterial preparations and 29 used single-strain probiotics . They were analysed regarding  patients included , treatment duration , probiotic dosage , and outcome measures . Results Trials in both groups suffered from heterogeneity with respect to probiotic concentration , duration of treatment , and other method ological issues ( crossover design and underpowered studies ) . This heterogeneity did not allow the application of a meta-analytic approach and a systematic review was therefore performed instead . Multi-strain preparations combined 2 to 8 different bacterial subspecies , mostly lactobacilli or bifidobacteria , and used variable lengths of treatments . Overall , more than 50 % of trials presented negative outcomes . The majority of the single-strain probiotic trials employing lactobacilli or Saccharomyces were negative , whereas trials employing bifidobacteria showed positive results . Conclusions The heterogeneity of the studies of probiotics in IBS questions the value of meta-analyses . The use of different bacterial strains and different mixtures of these strains , as well as different dosages , are the main contributors to this heterogeneity . Current data provides limited evidence for the efficacy of a small number of  single-strain probiotics  in IBS ( mostly bifidobacteria ) and sound studies following strict trial guidelines ( Food and Drug Administration and European Medicines Agency guidelines for clinical trials ) are needed . We summarised and proposed some method ological issues for future studies in the field
Probiotic interventions were effective for treatment and prevention of BV , prevention of recurrences of c and idiasis and UTIs , and clearing HPV lesions .
Although clinical practice recommendations were limited by the strength of evidence , probiotic interventions were effective in treatment and prevention of urogenital infections as alternatives or co-treatments .
INTRODUCTION Probiotics are a complementary and integrative therapy useful in the treatment and prevention of urogenital infections in women .
This study extends the work of research ers who systematic ally investigated the scientific literature on probiotics to prevent or treat urogenital infections .