Lactobacillus probiotics may prevent recurrent UTIs in postmenopausal women.

Context Urinary tract infection (UTI) is common; over half of all adult women will have a UTI, with a third having recurrent UTI. Women at higher risk of developing recurrence are older, postmenopausal, and incontinent and have cystocoeles with high postvoid residual volumes. Preventative strategies using prophylactic antibiotics may result in adverse side effects, antibiotic resistance and Clostridium difficile colitis. Therefore, women are increasingly looking for safe and effective nonantimicrobial alternatives. A recent systematic review and meta-analysis of randomised studies of products containing cranberry showed a protective effect against UTI, particularly in women with recurrent UTIs, children and subjects using products containing cranberry more than twice daily. Intravaginal oestrogens have also been found to reduce the number of UTIs in postmenopausal women with recurrent UTIs presumably by increasing intravaginal lactobacillus counts and decreasing uropathogenic bacteria. A recent study using Lactobacillus probiotics by oral administration restored vaginal lactobacilli flora and reduced colonisation of bacterial pathogens.