From the Guidelines
Lactobacillus species in urine should not be treated with antibiotics unless the patient is symptomatic and the organism is isolated in significant quantities, and instead, nonantibiotic alternatives such as lactobacillus containing probiotics can be considered for prevention and treatment of recurrent lower urinary tract infections in women. When considering the treatment of Lactobacillus species in urine, it is essential to prioritize the patient's symptoms and the potential benefits of treatment versus the risks of disrupting the normal flora. According to a study published in The Journal of Urology in 2018 1, an algorithmic approach to care that includes education on lifestyle and behavioral modifications, and addresses specific populations of women with antimicrobial-based and nonantibiotic alternatives is recommended. Some key points to consider when treating Lactobacillus species in urine include:
- The use of vaginal estrogen with or without lactobacillus containing probiotics in postmenopausal women
- Low dose post-coital antibiotics for recurrent urinary tract infection associated with sexual activity in premenopausal women
- Low dose daily antibiotic prophylaxis in premenopausal women with infections unrelated to sexual activity
- Methenamine hippurate and/or lactobacillus containing probiotics as nonantibiotic alternatives It is crucial to weigh the risks and benefits of treatment and consider the potential impact on the patient's quality of life and morbidity. In general, treatment should be based on clinical symptoms of urinary tract infection rather than the mere presence of Lactobacillus, and nonantibiotic alternatives such as lactobacillus containing probiotics can be a valuable option for prevention and treatment of recurrent lower urinary tract infections in women, as supported by the study published in The Journal of Urology in 2018 1.
From the Research
Lactobacillus Species in Urine Treatment
- The use of Lactobacillus species in preventing recurrent urinary tract infections (UTIs) has been studied in several clinical trials 2, 3, 4.
- A 2018 study found that Lactobacillus spp. containing products were able to prevent recurrent UTIs in females, with a pooled risk ratio of 0.684 (95% CI 0.438 to 0.929, p < 0.001) 2.
- Another study in 2013 found that probiotic Lactobacillus species were safe and effective in preventing recurrent UTIs in adult women, with a pooled risk ratio of 0.51 (95% CI 0.26-0.99, p = 0.05) 3.
- However, a 2012 study found that Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 did not meet the noninferiority criteria in preventing UTIs when compared with trimethoprim-sulfamethoxazole in postmenopausal women 4.
- It is also important to note that Lactobacillus species can cause septic urinary infections in rare cases, as seen in a 1984 study where Lactobacillus gasseri was found to be the cause of septic urinary infection in a 66-year-old patient 5.
Antibiotic Resistance
- The use of antibiotics to treat UTIs can lead to antibiotic resistance, as seen in a 2022 study where high resistance rates were found for trimethoprim-sulfamethoxazole, tetracycline, ciprofloxacin, levofloxacin, and cephalexin 6.
- The same study found that oral antibiotics with comparatively lower resistance rates included amoxicillin/clavulanate, cefdinir, cefuroxime, and nitrofurantoin 6.
- The use of Lactobacillus species as a non-antibiotic approach to prevent UTIs may help reduce the risk of antibiotic resistance, as seen in the 2012 study where Lactobacillus prophylaxis did not increase antibiotic resistance 4.