Urinary area: efficacy to be confirmed in clinical trials
Since lower urogenital infections seem closely related to a dysbiosis of the urinary or vaginal microbiota, treatments attempt to regulate the microbiota in order to prevent or even cure these conditions.
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Popular with patients, alternative treatments to antibiotics aim to prevent recurrence and antibiotic resistance. They are in line with the recommendations of health authorities, including the Haute Autorité de Santé (HAS) in France, which works to “encourage the appropriate use of antibiotics in order to reduce bacterial resistance that can lead to therapeutic deadlock”.15 Cranberries, in the form of a 36 mg/day dose of proanthocyanidin, can be used to prevent the recurrence of UTIs linked to E. coli.16
The depletion of the urinary microbiota in women susceptible to UTIs has raised the question of whether an intake of microorganisms via probiotics can reduce UTI rates. An ideal probiotic should have the ability to adhere to cells, prevent and reduce the adhesion of pathogens, secrete acids (e.g. lactic acid), hydrogen peroxide and bactericides capable of reducing the growth of pathogens, be free of adverse side-effects (they should not be invasive, carcinogenic or pathogenic) and be capable of forming clumps to produce normal, balanced flora.17
According to the literature, probiotics have proven effective in the treatment and prevention of urogenital infections.17 Certain lactobacilli (L. rhamnosus, L. fermentum and L. reuteri) have been shown to have a beneficial effect in treating urinary tract infections.18 An inhibitory effect on E. coli has been demonstrated in vitro, with certain strains of lactobacilli (L. rhamnosus and L. plantarum) possessing antimicrobial properties against this bacterium.19
Therefore, the data increasingly suggests that probiotics may be used as a first step in the regulation of urinary microbiota in order to reduce the risk of, or treat, certain urinary infections, particularly since they are safe, better tolerated than antibiotics and frequently requested by patients.17 However, further clinical trials involving large numbers of patients will be required to obtain clear evidence on the preventive and curative role of probiotics in urinary tract infections.17
15 Has-sante. acute-simple-cystitis-cystitis-with-risk-of-complication-or-recurrent-cystitis-in-women, 23/01/2020
16 Caron F, Galperine T, Flateau C et al. Practice guidelines for the management of adult community-acquired urinary tract infections. Med Mal Infect. 2018;48(5):327-358.
17 Akgül T, Karakan T. The role of probiotics in women with recurrent urinary tract infections. Turk J Urol. 2018;44(5):377-383.
18 Aragón IM, Herrera-Imbroda B, Queipo-Ortuño MI, et al. The Urinary Tract Microbiome in Health and Disease. Eur Urol Focus. 2018;4(1):128-138.
19 Mogna L, Del Piano M, Deidda F, et al. Assessment of the in vitro inhibitory activity of specific probiotic bacteria against different Escherichia coli strains. J Clin Gastroenterol. 2012;46 Suppl:S29-S32.
20 van de Wijgert J, Verwijs MC. Lactobacilli-containing vaginal probiotics to cure or prevent bacterial or fungal vaginal dysbiosis: a systematic review and recommendations for future trial designs. BJOG. 2020;127(2):287-299.