Lactobacillus probiotic species were not as effective as trimethoprim-sulfamethoxazole (TMS) in clearing urinary tract infections (UTIs) in postmenopausal women with recurrent UTIs, according to a study published in the May 14 issue of the Archives of Internal Medicine.
In a randomized, double-blind, noninferiority trial, investigators randomly assigned 252 postmenopausal women with recurrent UTIs to receive 12 months of prophylaxis with either TMS (480 mg once daily) or oral capsules containing L rhamnosus GR-1 and L reuteri RC-14 (twice daily). Women treated with lactobacilli prophylactically for 12 months saw a reduction in the mean number of UTIs from 6.8 to 3.3, whereas those women treated with prophylactic TMS had a reduction in the number of UTIs from 7.0 to 2.9. This resulted in a between-treatment difference of 0.4 UTIs per year.
The researchers also found that resistance to TMS, trimethoprim, and amoxicillin increased from approximately 20% to 40% to approximately 80% to 95%. Treatment with lactobacilli did not increase antibiotic resistance. The researchers note that the "development of antibiotic resistance is considerably lower with use of lactobacilli. Therefore, lactobacilli may be an acceptable alternative for prevention of UTIs, especially in women who dislike taking antibiotics. Unfortunately, the use of antibiotics for UTI prevention is becoming more problematic because resistance to commonly used agents is now widespread, infection caused by Clostridium difficile is increasingly common, and our appreciation of the importance of an undisturbed microbiome in health is growing."
Steve: do we love to see this or what?!