Antibiotics prevent UTIs better than probiotics

Antibiotics are still better than probiotics at preventing urinary tract infections, a new study concludes - but at a cost of some antibiotic resistance.

Dr Suzanne Geerlings, from the Academic Medical Centre at the University of Amsterdam in The Netherlands, and her colleagues recruited 252 women between 2005 and 2007 for a randomised double-blind trial.

The participants, who lived in communities surrounding the medical centre, were all postmenopausal – a time when vulnerability to UTIs increases because of hormonal changes, according to the researchers.

All the participants reported having had at least three UTIs in the year before the trial began, and the average number was seven.

One more UTI in women

For the study, the women were assigned to take either co-trimoxazole or Lactobacillus rhamnosus GR-1 or L. reuteri RC-14 every day for twelve months.

Overall, the antibiotic was slightly better at keeping UTIs at bay.

About 69% of the women taking the antibiotic had one or more UTIs within the year, or 2.9 UTIs per woman. In the probiotic group, about 79% had a UTI within the year, with an average of 3.3 UTIs per woman.

The women taking the antibiotic also seemed to go twice as long without a UTI – six months, compared with three months among women taking the probiotics.

Based on urine and faeces samples, however, resistance to a range of antibiotics seemed to increase within the first month in the antibiotic group.

Lactobacilli acceptable UTI prevention

Before the study, about 20% to 40% of Escherichia coli in samples from all the women were resistant to co-trimoxazole.

At the 12-month mark, 80% to 95% of E-coli was resistant in the women taking the antibiotic.

Rates of resistant E-coli were slightly lower at 12 months in women taking the probiotics than when the study began.

Similar changes were seen in resistance to other antibiotics, including ciprofloxacin and gentamicin, among both groups of women – which the researchers speculate might be because the same mechanism in certain bacteria allows them to resist several different drugs.

The absence of increased resistance among women taking the probiotics means that "lactobacilli may be an acceptable alternative for prevention of UTIs, especially in women who dislike taking antibiotics," the researchers wrote in the Archives of Internal Medicine.

Participants don’t think treatment is working

The study, however, had several limitations.

More than 80 women dropped out of the study by the end of the year because of side effects and other reasons. A greater number of those taking the probiotics had diarrhoea compared to those taking the antibiotics, for instance. Other reasons for dropping out included the participant not thinking the treatment was working, or she couldn't adhere to study's directions.

As a result, the researchers did not have the number of participants in each group to give the findings statistical weight.

Despite the study's weaknesses, a commentary published in the same journal called the findings "exciting and compelling."

"I think we need to appreciate that the normal flora in our body is another system we need for good health and antibiotics disrupt it and leave lasting effects... We need to think of antibiotics as a situation that has some risk," Dr Barbara Trautner, one of the commentary's authors, told Reuters Health.

Women avoid using hormones

Dr Trautner, of the Michael E. DeBakey Veterans Affairs Medical Centre and Baylor College of Medicine in Houston, said that probiotics may be an acceptable alternative but they need further exploration.

Topical oestrogen creams are sometimes used to prevent UTIs in menopausal women, but many women prefer to avoid using hormones.

In her commentary, Dr Trautner wrote that 60% of women in the United States experience UTIs or bladder infections during their lifetimes, and they recur in about a third of those women.

"We don't have terrific preventive strategies so a probiotic approach would be beneficial and promising," Dr Trautner said.

For right now, she said most women with recurring UTIs have exhausted any type of behavioural changes that might help prevent the infections, and are left with low-dose antibiotics as their only recourse.

(Andrew M. Seaman, Reuters Health, May 2012)

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