Two studies went one step
further by examining human prophylaxis
with Lactobacilli, either
orally or vaginally, as means to
prevent recurrent UTIs. Beerepoot
et al. (2012) compared the effects
of oral L. rhamnosus and L.
reuteri (109 CFU twice daily) with
trimethoprim-sulfamethoxazole
(TMP-SMX, 480 mg daily) on
preventing recurrent UTIs in 252
postmenopausal women. In their
randomized control trial, they
found that after 12 months of
prophylaxis, the mean number of
symptomatic UTIs decreased
form 7.0 (from the previous year)
to 2.9 in the TMP-SMX group
and from 6.8 to 3.3 in the
Lactobacilli group. Although
TMP-SMX decreased the number
of symptomatic UTIs more than
the Lactobacilli, both methods of
prophylaxis groups were effective
in significantly reducing the
number of recurrent UTIs in
women. At least one UTI with
bothersome symptoms occurred
in 69.3% and 79.1% of the individuals
taking TMP-SMX and
Lactobacilli; median time to the
first recurrent UTI were six and
three months. Although Lacto -
bacilli was not found noninferior
to TMP-SMX with regard to de -
creasing mean number of symptomatic
UTIs, proportion of individuals
with UTIs or time to the
first UTI, the authors did find
some benefits of Lactobacilli over
TMP-SMX for prophylactic use.
Antibiotic resistance from E.
coli (causing UTI and in urine
and feces of asymptomatic
women) to sulfamethoxazole,
trimethoprim and amoxicillin
increased after one month from
20% to 40% to 80% to 95% in
the TMP-SMX group. After 12
months of TMP-SMX prophylaxis,
100% of urinary E. coli was
found resistant to trimethoprim
and sulfam eth oxazole. No antibiotic
resistance occurred in the
Lactobacilli group. In addition,
Lactobacilli may be more effective
in preventing complicated
UTIs. The authors found that
women with complicated UTIs
experienced an average of 4.4