Utilization of the Intestinal Tract as a Delivery System for Urogenital Probiotics Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. Efficacy of low-dose intravaginal estriol on urogenital aging in postmenopausal women A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women. Contribution of HIV-1 infection to acquisition of sexually transmitted disease: a 10-year prospective study. Lactic acid bacteria colonization and clinical outcome after probiotic supplementation in conventionally treated bacterial vaginosis and vulvovaginal candidiasis. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. Effect of nonoxynol-9 gel on urogenital gonorrhea and chlamydial infection: a randomized controlled trial. Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial Prevalence of bacterial vaginosis and impact of genital hygiene practices in non-pregnant women in zanjan, iran. Triple therapy with Lactobacilli acidophili, estriol plus pelvic floor rehabilitation for symptoms of urogenital aging in postmenopausal women A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection. Antibiotic Treatment to Prevent Urinary Tract Infections after Urodynamic Evaluation
 Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women Probiotics Feeding in Prevention of Urinary Tract Infection, Bacterial Sepsis and Necrotizing Enterocolitis in Preterm Infants Prevalence of Genitourinary Symptoms in the Late Menopause Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 to prevent or cure bacterial vaginosis among women with HIV. [Influence of probiotics and fibre on the incidence of bacterial infections following major abdominal surgery - results of a prospective trial]. Uncomplicated Bacterial Communityacquired Urinary Tract Infection in Adults. Probiotics and prebiotics in gastrointestinal disorders Oral probiotics influence oral and respiratory tract infections in pediatric population: a randomized double-blinded placebo-controlled pilot study. Improved cure of bacterial vaginosis with single dose of tinidazole (2 g), Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14: a randomized, double-blind, placebo-controlled trial.
Orally consumed viable bacteria with proposed beneficial health effects , the so-called probiotics , are increasingly used to treat disorders of the gastrointestinal tract . It has been recently suggested that specifically selected lactobacilli could have a therapeutic role in female urogenital tract infections . It has been also suggested that some of these bacteria could be not intravaginally instilled , but also orally delivered . The authors investigate the ability of lactobacilli isolated from the vagina to survive gastrointestinal tract transit , and establish a link between the rate of intestinal survival and vaginal colonization Bacterial vaginosis ( BV ) is particularly common in black women , and in Nigeria it is often caused by Mycoplasma , as well as Atopobium , Prevotella and Gardnerella sp. Antimicrobial metronidazole oral therapy is poorly effective in eradicating the condition and restoring the Lactobacillus microbiota in the vagina . In this study , 40 women diagnosed with BV by discharge , fishy odor , sialidase positive test and Nugent Gram stain scoring , were r and omized to receive either two dried capsules containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 each night for 5 days , or 0.75 % metronidazole gel , applied vaginally twice a day ( in the morning and evening ) . Follow-up at day 6 , 15 and 30 showed cure of BV in significantly more probiotic treated subjects ( 16 , 17 and 18/20 , respectively ) compared to metronidazole treatment ( 9 , 9 and 11/20 : P=0.016 at day 6 , P=0.002 at day 15 and P=0.056 at day 30 ) . This is the first report of an effective ( 90 % ) cure of BV using probiotic lactobacilli . Given the correlation between BV and HIV , and the high risk of the latter in Nigeria , intravaginal use of lactobacilli could provide women with a self-use therapy , similar to over-the-counter anti-yeast medication , for treatment of urogenital infections Forty-two healthy women were r and omized to receive one of three encapsulated Lactobacillus rhamnosus GR-1 plus Lactobacillus fermentum RC-14 probiotic dosage regimens or L. rhamnosus GG by mouth each day for 28 days . However , the vaginal flora , assessed by Nugent scoring , was only normal in 40 % of the cases , and 14 patients had asymptomatic bacterial vaginosis . Treatment with L. rhamnosus GR-1/L. fermentum RC-14 once and twice daily correlated with a healthy vaginal flora in up to 90 % of patients , and 7/11 patients with bacterial vaginosis converted to normal or intermediate scores within 1 month . Ingestion of L. rhamnosus GG failed to have an effect . This study confirms the potential efficacy of orally administered lactobacilli as a non-chemotherapeutic means to restore and maintain a normal urogenital flora , and shows that over 10(8 ) viable organisms per day is the required dose Objective To assess the efficacy and safety of intravaginal estriol administration on  urinary incontinence , urogenital atrophy , and recurrent urinary tract infections in postmenopausal women . Design Eighty-eight postmenopausal women with urogenital aging symptoms were enrolled in this prospect i ve , r and omized , placebo-controlled study . Participants were r and omly divided into two groups , with each group consisting of 44 women . Women in the treatment group received intravaginal estriol ovules : 1 ovule ( 1 mg ) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy . Women in the control group received inert placebo vaginal suppositories in a similar regimen . We evaluated urogenital symptomatology , urine cultures , colposcopic findings , urethral cytologic findings , urethral pressure profiles , and urethrocystometry before as well as after 6 months of treatment . Results After therapy , the symptoms and signs of urogenital atrophy significantly improved in the treatment group in comparison with the control group . Thirty ( 68 % ) of the treated participants , and only seven ( 16 % ) of the control participants registered a subjective improvement of their incontinence . In the treated participants , we observed significant improvements of colposcopic findings , and there were statistically significant increases in mean maximum urethral pressure , in mean urethral closure pressure as well as in the abdominal pressure transmission ratio to the proximal urethra . Urethrocystometry showed positive but not statistically significant modifications . Conclusions Our results show that intravaginal administration of estriol may represent a satisfactory therapeutic choice for those postmenopausal women with urogenital tract disturbances who have contraindications or refuse to undergo st and ard hormone therapy OBJECTIVE The primary objective was to detect a difference in time until the first recurrence of urinary tract infection during treatment with an estradiol-releasing silicone vaginal ring ( Estring ; Pharmacia & Upjohn , Inc , Uppsala , Sweden ) compared with no estrogen treatment . The secondary objective was to detect any differences in improvement of urethral and vaginal mucosal atrophy and in the subjective assessment of urogenital symptoms . The study also sought to detect a difference in decrease of vaginal pH to < 5.5 and to record adverse events . STUDY DESIGN This was a multicenter , r and omized , open , parallel-group study with an untreated control group . Postmenopausal women with recurrent symptomatic , bacteriologically confirmed urinary tract infections were r and omly assigned to receive either Estring ( 2 mg estradiol ) or no estrogen treatment . One ring was carried vaginally for 12 weeks . The duration of treatment was 36 weeks for the Estring group and either 36 weeks or until the first recurrence for the control group . Both intent-to-treat and per- protocol analyses were performed to evaluate efficacy , whereas the safety analysis was limited to the intent-to-treat group . The primary variable was analyzed by survival analysis with the Kaplan-Meier method for estimating the survival density function . To compare the survival curves for the 2 treatment groups a log-rank test was performed for time until first recurrence . RESULTS A total of 108 women were r and omly assigned , 53 to the Estring group and 55 to the control group . The cumulative proportion of women remaining free of urinary tract infection was significantly higher in the Estring group than in the control group ( P = .008 ) . After 36 weeks of study the cumulative likelihood of remaining free of disease was approximately 45 % in the women with the vaginal ring compared with approximately 20 % in the control group . Estring lowered vaginal pH , and the time to first recurrence was effectively prolonged by Estring treatment . Vaginal and , to a lesser extent , urethral mucosal cells were significantly more mature in the Estring group . No unexpected adverse events were found . CONCLUSION Estring is useful to prolong the time to next recurrence among postmenopausal women with recurrent urinary tract infection and to decrease the number of recurrences per year . The silicone vaginal ring also has a clinical ly significant ability to alleviate other postmenopausal urogenital symptoms . Estring is safe and well tolerated BACKGROUND Sexually transmitted diseases ( STDs ) enhance human immunodeficiency virus (HIV)-1 susceptibility , but few studies have examined the reciprocal effect of HIV-1 on STD acquisition . METHODS Data from a prospect i ve cohort study conducted among female sex workers in Mombasa , Kenya between 1993 and 2003 were used to determine the effect of HIV-1 infection on STD susceptibility . The cohort included 1215 HIV-1-seronegative women who underwent monthly HIV-1 and STD screening , of whom 238 experienced seroconversion to HIV-1 during follow-up . And ersen-Gill proportional-hazards models were used to compare the incidence rates for genital-tract infections ( syphilis , genital ulcer disease [ GUD ] , Neisseria gonorrhoeae infection , Chlamydia trachomatis infection , Trichomonas vaginalis infection , vulvovaginal c and idiasis , and bacterial vaginosis ) in HIV-1-seropositive versus HIV-1-seronegative women , after controlling for sexual behavior and other potential confounding factors . RESULTS HIV-1 infection was associated with a significantly higher incidence of GUD ( hazard ratio [ HR ] , 2.8 ; 95 % confidence interval [ CI ] , 2.0 - 3.9 ) , gonorrhea ( HR , 1.6 ; 95 % CI , 1.1 - 2.2 ) , and vulvovaginal c and idiasis ( HR , 1.5 ; 95 % CI , 1.3 - 1.8 ) . The risks of GUD and vulvovaginal c and idiasis increased with progressive levels of immunosuppression . CONCLUSIONS The increased incidence of genital-tract infections among HIV-1-seropositive women could promote the spread of both HIV-1 and other STDs , particularly in areas where these conditions are highly prevalent This r and omized double-blind placebo controlled study assessed the vaginal colonization of lactic acid bacteria and clinical outcome . Vaginal capsules containing L gasseri LN40 , Lactobacillus fermentum LN99 , L. casei subsp . rhamnosus LN113 and P. acidilactici LN23 , or placebos were administered for five days to 95 women after conventional treatment of bacterial vaginosis and /or vulvovaginal c and idiasis . Vulvovaginal examinations and vaginal samplings were performed before and after administration , after the first and second menstruation , and after six months . Presence of LN strains was assessed using RAPD analysis . LN strains were present 2 - 3 days after administration in 89 % of the women receiving LN strains ( placebo : 0 % , p < 0.0001 ) . After one menstruation 53 % were colonized by at least one LN strain . Nine percent were still colonized six months after administration . Ninety-three percent of the women receiving LN strains were cured 2 - 3 days after administration ( placebo : 83 % ) , and 78 % after one menstruation ( placebo : 71 % ) ( ns ) . The intervention group experienced less malodorous discharge 2 - 3 days after administration ( p = 0.03 ) and after the second menstruation ( p = 0.04 ) , compared with placebo . In summary , five days of vaginal administration of LN strains after conventional treatment of bacterial vaginosis and /or vulvovaginal c and idiasis lead to vaginal colonization , somewhat fewer recurrences and less malodorous discharge Urogenital infections afflict an estimated one billion people each year . The size of this problem and the increased prevalence of multi-drug resistant pathogens make it imperative that alternative remedies be found . A r and omized , placebo-controlled trial of 64 healthy women given daily oral capsules of Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 for 60 days showed no adverse effects . Microscopy analysis showed restoration from asymptomatic bacterial vaginosis microflora to a normal lactobacilli colonized microflora in 37 % women during lactobacilli treatment compared to 13 % on placebo ( P=0.02 ) . Lactobacilli were detected in more women in the lactobacilli-treated group than in the placebo group at 28 day ( P=0.08 ) and 60 day ( P=0.05 ) test points . Culture findings confirmed a significant increase in vaginal lactobacilli at day 28 and 60 , a significant depletion in yeast at day 28 and a significant reduction in coliforms at day 28 , 60 and 90 for lactobacilli-treated subjects versus controls . The combination of probiotic L. rhamnosus GR-1 and L. fermentum RC-14 is not only safe for daily use in healthy women , but it can reduce colonization of the vagina by potential pathogenic bacteria and yeast CONTEXT Nonoxynol-9 has been suggested as a vaginal microbicide to protect against common sexually transmitted infections . OBJECTIVE To compare nonoxynol-9 gel and condom use ( gel group ) vs condom use alone ( condom group ) for the prevention of male-to-female transmission of urogenital gonococcal and chlamydial infection . DESIGN AND SETTING R and omized controlled trial conducted at 10 community clinics and 10 pharmacies in Yaoundé , Cameroon , between October 1998 and September 2000 , with 6 months of follow-up . PARTICIPANTS High-risk population of 1251 women ( excluding sex workers ) being treated for or who had symptoms of sexually transmitted infections . Three were excluded from the gel group ( 0.5 % ) and 7 from the condom group ( 1 % ) because of no follow-up data . INTERVENTIONS Nonoxynol-9 gel ( 100 mg ) and condoms or condoms only . MAIN OUTCOME MEASURE A positive test result for gonococcal or chlamydial infection by the ligase chain reaction assay ; secondary outcome measure was a positive test result for human immunodeficiency virus ( HIV ) . RESULTS The rate ratio ( RR ) for new urogenital infections was 1.2 for the gel group vs condom group ( 95 % confidence interval [ CI ] , 0.9 - 1.6 ; P = .21 ) . The gel group had 116 diagnosed gonococcal infections , chlamydial infections , or both for a rate of 43.6 per 100 person-years , and the condom group had 100 infections for a rate of 36.6 per 100 person-years . The RR for gonococcal infection in the gel group vs the condom group was 1.5 ( 95 % CI , 1.0 - 2.3 ) and for chlamydial infection was 1.0 ( 95 % CI , 0.7 - 1.4 ) . There were 5 new cases of HIV infections in the gel group and 4 in the condom group . Three women in each group became pregnant during the study . CONCLUSION Nonoxynol-9 gel did not protect against urogenital gonococcal or chlamydial infection Objective To determine the prevalence of bacterial vaginosis in women undergoing first trimester suction termination of pregnancy and to evaluate the efficacy of metronidazole in reducing the risk of post abortal pelvic infection in women with bacterial vaginosis OBJECTIVES Bacterial vaginosis is one of the most common causes of reproductive tract infection ( RTI ) , it 's prevalence is influenced by many factors . The aim of this study is to determine the prevalence of bacterial vaginosis and impact of sexual and genital hygienie practice s and socio-demographic characteristics in non pregnant women of Zanjan province in Iran . METHODS 500 non-pregnant , married women were r and omly selected for this study . This is a descriptive-analytic study conducted among non-pregnant referred to primry healthcare centres in Zanjan between May to August 2006 . Following gynecological examination and vaginal sample collection by physicians , bacterial vaginosis was confirmed by Nugent criteria , tricomoniasis by direct microscopy and c and idiasis by direct microscopic observation and evaluation of presenting clinical signs of vulvovaginitis . RESULTS The prevalence of RTI was 27.6 % . Out of which 16.2 % was devoted to bacterial vaginosis ( BV ) , 6.6 % to trichomoniasis and 4.8 % to Vulvovaginal c and idiasis ( VVC ) . In contrast to coital hygiene , there was a significant correlation between menstrual and individual vaginal hygiene and BV ( p<0.01 and p<0.001 ) respectively . There was a significant correlation between BV and education ( p<0.025 ) , number of pregnancy ( p<0.05 ) and method of contraception ( p<0.005 ) . No significant correlation was observed between age , age of marriage and abortion . CONCLUSION The data obtained suggests that the prevalence rate of BV is relatively high and could be affected by hygiene behaviors and certain socio-demographic characteristics , which indicate the need for comprehensive , scheduled programs of healthcare educations , aim ed at reducing BV prevalence Abstract Purpose To assess the effects of the combination of pelvic floor rehabilitation , intravaginal estriol and Lactobacillus acidophli administration on stress urinary incontinence ( SUI ) , urogenital atrophy and recurrent urinary tract infections in postmenopausal women . Methods 136 postmenopausal women with urogenital aging symptoms were enrolled in this prospect i ve r and omized study . Patients : r and omly divided into two groups and each group consisted of 68 women . Interventions : Subjects in the triple therapy ( group I ) received 1 intravaginal ovule containing 30 mcg estriol and Lactobacilli acidophili ( 50 mg lyophilisate containing at least 100 million live bacteria ) such as once daily for 2 weeks and then two ovules once weekly for a total of 6 months as maintenance therapy plus pelvic floor rehabilitation . Subjects in the group II received one intravaginal estriol ovule ( 1 mg ) plus pelvic floor rehabilitation in a similar regimen . Mean outcome measures : We evaluated urogenital symptomatology , urine cultures , colposcopic findings , urethral cytologic findings , urethral pressure profiles and urethrocystometry before , as well as after 6 months of treatment . Results After therapy , the symptoms and signs of urogenital atrophy significantly improved in both groups . 45/59 ( 76.27 % ) of the group I and 26/63 ( 41.27 % ) of the group II referred a subjective improvement of their incontinence . In the patients treated by triple therapy with lactobacilli , estriol plus pelvic floor rehabilitation , we observed significant improvements of colposcopic findings , and there were statistically significant increases in mean maximum urethral pressure , in mean urethral closure pressure , as well as in the abdominal pressure transmission ratio to the proximal urethra . Conclusions Our results showed that triple therapy with L. acidophili , estriol plus pelvic floor rehabilitation was effective and should be considered as first-line treatment for symptoms of urogenital aging in postmenopausal women Changes in the indigenous vaginal microflora with uropathogenic bacteria can predispose women to frequently recurring bacterial cystitis . Lactobacilli used as probiotics have played an important role in preventing the colonization of pathogenic bacteria in the vagina . A prospect i ve clinical pilot study was performed to confirm the safety and effectiveness of Lactobacillus vaginal suppositories against the recurrence of bacterial urinary tract infection ( UTI ) . The patients enrolled in the study were instructed to administer vaginal suppositories containing the strain Lactobacillus crispatus GAI 98322 . A significant reduction in the number of recurrences was noted , without any adverse complication ( P=0.0007 ) . The administration of vaginal suppositories containing L. crispatus GAI 98332 seemed to be a safe and promising treatment for the prevention of recurrent UTI Abstract : The aim of the study was to determine the efficacy of cotrimoxazole administration after urodynamic testing to prevent urinary tract infections . In a single-blind prospect i ve r and omized study 94 women who attended for urodynamic evaluation were included . After multichannel urodynamic testing , including two catheterizations , the women received a single dose of cotrimoxazole or placebo . A clean-catch urine specimen was tested for infection after 1 week . Seventy women returned a urine specimen after 1 week : 2/37 ( 5.4 % ) in the treatment and 2/33 ( 6.1 % ) in the placebo group had acquired a new urinary tract infection after urodynamics . One major and one minor adverse reaction to cotrimoxazole were reported . The power of the sample size was unfortunately too small to draw conclusions as to the efficacy of prophylaxis Purpose To assess the effects of the combination of pelvic floor rehabilitation and intravaginal estriol administration on  stress urinary incontinence ( SUI ) , urogenital atrophy and recurrent urinary tract infections in postmenopausal women . Methods Two-hundred-six postmenopausal women with urogenital aging symptoms were enrolled in this prospect i ve r and omized controlled study . Patients were r and omly divided into two groups and each group consisted of 103 women . Subjects in the treatment group received intravaginal estriol ovules , such as 1 ovule ( 1 mg ) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy plus pelvic floor rehabilitation . Subjects in the control group received only intravaginal estriol in a similar regimen . We evaluated urogenital symptomatology , urine cultures , colposcopic findings , urethral cytologic findings , urethral pressure profiles and urethrocystometry before , as well as after 6 months of treatment . Results After therapy , the symptoms and signs of urogenital atrophy significantly improved in both groups . 61/83 ( 73.49 % ) of the treated patients , and only 10/103 ( 9.71 % ) of the control patients referred a subjective improvement of their incontinence . In the patients treated by combination therapy with estriol plus pelvic floor rehabilitation , we observed significant improvements of colposcopic findings , and there were statistically significant increases in mean maximum urethral pressure ( MUP ) , in mean urethral closure pressure ( MUCP ) , as well as in the abdominal pressure transmission ratio to the proximal urethra ( PTR ) . Conclusions Our results showed that combination therapy with estriol plus pelvic floor rehabilitation was effective and should be considered as a first-line treatment for symptoms of urogenital aging in postmenopausal women Background : It has been suggested that probiotics can reduce the overgrowth of pathogens in the bowels of preterm infants and contribute to the reduction of the incidence of nosocomial infections in neonatal intensive care units ( NICUs ) . The purpose of this study was to evaluate the effectiveness of Lactobacillus GG supplementation in reducing the incidence of urinary tract infections ( UTIs ) , bacterial sepsis and necrotizing enterocolitis ( NEC ) in preterm infants . Methods : A double-blind study was conducted in 12 Italian NICUs . Newborn infants with a gestational age <33 weeks or birthweight < 1,500 g were r and omized to receive st and ard milk feed supplemented with Lactobacillus GG ( Dicoflor ® , Dicofarm , Rome , Italy ) in a dose of 6 × 109 colony-forming units ( cfu ) once a day until discharge , starting with the first feed or placebo . Results : Five hundred eighty-five patients were studied . The probiotics group ( n = 295 ) and the placebo group ( n = 290 ) exhibited similar clinical characteristics . The duration  of Lactobacillus GG and placebo supplementation was 47.3 ± 26.0 and 48.2 ± 24.3 days , respectively . Although UTIs ( 3.4 vs. 5.8 % ) and NEC ( 1.4 vs. 2.7 % ) were found less frequently in the probiotic group compared to the control group , these differences were not significant . Bacterial sepsis was more frequent in the probiotics group ( 4.4 % , n = 11 ) than in the placebo group ( 3.8 % , n = 9 ) , but the difference was not significant . Conclusion : Seven days of Lactobacillus GG supplementation starting with the first feed is not effective in reducing the incidence of UTIs , NEC and sepsis in preterm infants . Further studies are required to confirm our results in lower birthweight population Abstract . One thous and two hundred women , aged 61 , r and omly selected from a defined geographical area in South Sweden , were interviewed by an anonymous question naire about their urogenital symptoms . Seventy‐five percent cooperated , of whom 29.2 % admitted to some degree of urinary incontinence and 48.8 % some degree of lower genital tract disorder . Stress incontinence symptoms were reported by 11.8 % of the women , urge incontinence by 7.9 % and both types combined—“mixed ” by 9.5 % . Four percent of all women ( 18 % of stress incontinence ) experienced a loss sufficient to necessitate the wearing of a sanitary napkin or change of under clothing several times a day . Thirteen percent had repeated urinary tract infections . Itch , discharge and smarting pain was reported by 15 % . Thirty‐eight percent had vaginal dryness and dyspareunia . Only 4 % of the women were undergoing estrogen therapy OBJECTIVE To assess , among women with HIV , whether long-term oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 supplementation can prevent bacterial vaginosis ( BV ) and enhance the cure rate of metronidazole  among those with BV . METHODS A r and omized , double-blind , placebo-controlled trial conducted among 65 HIV-infected women with an aberrant microbiota ( Nugent score 4 - 10 ) who were r and omized to receive daily probiotics or placebo for 6 months . Those with BV ( Nugent score 7 - 10 ) additionally received metronidazole for 10 days ( 400 mg twice daily ) . RESULTS We did not find an enhanced cure rate of BV among women with HIV treated with adjuvant probiotics to metronidazole treatment . Among women with an intermediate vaginal flora , probiotics tended to increase the probability of a normal vaginal flora ( odds ratio 2.4 ; P=0.1 ) and significantly increased the probability of a beneficial vaginal pH ( odds ratio 3.8 ; P=0.02 ) at follow-up . CONCLUSION Supplementation of probiotic L. rhamnosus GR-1 and L. reuteri RC-14 did not enhance the cure of BV among women living with HIV , but may prevent the condition among this population . TRIAL REGISTRATION NCT00536848 INTRODUCTION Early enteral nutrition with fibre and probiotics has been effective in preventing bacterial translocation and is therefore expected to reduce the incidence of postoperative bacterial infections . PATIENTS AND METHODS In a prospect i ve r and omized trial including 172 patients following major abdominal surgery or liver transplantation , the incidence of bacterial infections was compared in patients receiving either a ) conventional parenteral or enteral nutrition  , b ) enteral nutrition with fibre and lactobacillus plantarum 299 or c ) enteral nutrition with fibre and heat inactivated lactobacilli ( placebo ) .  Liver transplant recipients were also treated with selective bowel decontamination ( SBD ) .  Routine laboratory parameters , nutritional parameters and the cellular immune status were measured preoperatively and on postoperative days 1 , 5 and 10 . RESULTS Patients were comparable regarding preoperative ASA-classification , Child-Pugh classification of cirrhosis , operative data and immunosuppression . The incidence of bacterial infections after liver , gastric oder pancreas resection was 31 % in the conventional group a ) compared to 4 % in the lactobacillus-group b ) and 13 % in the placebo-group c ) . In the analysis of 95 liver transplant recipients , 13 % group b)- patients developed infections compared to 48 % group a)- patients and 34 % group c)- patients . The difference between groups a ) and b ) was statistically significant in both cases . In addition , the duration of antibiotic therapy was significantly shorter in the lactobacillus-group . Cholangitis and pneumonia were the most frequent infections and enterococci the most frequently isolated bacteria . Fibre and lactobacilli were well tolerated in most cases . CONCLUSION Fibre and probiotics could lower the incidence of bacterial infections following major abdominal surgery in comparison to conventional nutrition with or without SBD . With this new concept , costs can be reduced by shortening the duration of antibiotic therapy and sparing SBD BACKGROUND Uncomplicated bacterial community-acquired urinary tract infection is among the more common infections in outpatient practice . The resistance level of pathogens has risen markedly . This S3 guideline contains recommendations based on current evidence for the rational use of anti - microbial agents and for the prevention of inappropriate use of certain classes of antibiotics and thus of the result ing drug resistance . The prevention of recurrent urinary tract infection is considered in this guideline for the first time . METHODS The guideline was up date d under the aegis of the German Urological Society ( Deutsche Gesellschaft für Urologie ) . A systematic literature search ( period : 2008 - 2015 ) concerning the diagnosis , treatment , and prevention of uncomplicated urinary tract infections was carried out in the Cochrane Library , MEDLINE , and Embase data bases . R and omized , controlled trials and systemic review s were included . Relevant guidelines were identified in a guideline synopsis . RESULTS Symptom-oriented diagnostic evaluation is highly valued . For the treatment of cystitis , fosfomycin-trometamol , nitrofurantoin , nitroxolin , pivmecillinam and trimethoprim are all equally recommended . Fluorquinolones and cephalosporins are not recommended . Uncomplicated pyelonephritis with a mild to moderate clinical course ought to be treated with oral cefpodoxime , ceftibuten , ciprofloxacin , or levofloxacin . For acute , uncomplicated cystitis , with mild to moderate symptoms , symptomatic treatment alone may be considered instead of antibiotics after discussion of the options with the patient . Mainly non-antibiotic measures are recommended for prophylaxis against recurrent urinary tract infection . CONCLUSION Physicians who treat uncomplicated urinary tract infections should familiarize themselves with the newly revised guideline 's recommendations on the selection and dosage of antibiotic treatment so that they can responsibly evaluate and plan antibiotic treatment for their affected patients Purpose of review This review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect . Recent findings The demonstration that immune and epithelial cells can discriminate between different microbial species has extended the known mechanism(s ) of action of probiotics beyond simple barrier and antimicrobial effects . It has also confirmed that probiotic bacteria modulate mucosal and systemic immune activity and epithelial function . The progressive unraveling of these mechanisms of action has led to new credence for the use of probiotics and prebiotics in clinical medicine . Level I evidence now exists for the therapeutic use of probiotics in infectious diarrhea in children , recurrent Clostridium difficile – induced infections and postoperative pouchitis . Level II evidence is emerging for the use of probiotics in other gastrointestinal infections , prevention of postoperative bacterial translocation , irritable bowel syndrome , and in both ulcerative colitis and Crohn disease . Nevertheless , one consistent feature has emerged over the past year : Not all probiotic bacteria have similar therapeutic effects . Future clinical trials will need to incorporate this fact into trial planning and design . Summary The use of probiotics and prebiotics as therapeutic agents for gastrointestinal disorders is rapidly moving into the “ mainstream . ” Mechanisms of action explain the therapeutic effects and r and omized ; controlled trials provide the necessary evidence for their incorporation into the therapeutic armamentarium OBJECTIVE Acute oral and respiratory tract infections ( RTIs ) are highly present in the general population , and they represent one of the most impacting causes of morbidity and mortality every year . The aim of our study was to assess the clinical impact of oral probiotics on acute oral and respiratory tract infections affecting paediatric patients . PATIENTS AND METHODS This is a r and omized , double-blinded placebo-controlled clinical study , where probiotics have been compared with placebo in a double-blinded investigation . 40 subjects with a recent clinical history reporting oral and respiratory tract infections were r and omly selected and assigned to control ( n=20 ) or the probiotics ( n=20 ) group . During the 3 months before the starting , all subjects were assessed with several salivary examinations . RESULTS We found significant differences in the incidence of oral and respiratory tract infections between control and probiotic group , with a marked reduction of oral and respiratory tract infections episodes in the probiotic group . Salivary examinations gave similar results in both the groups , however , despite the salivary flow , viscosity and buffering were similar , on the contrary , pH values were found to be more alkaline in patients of probiotic group . CONCLUSIONS This study showed the main positive effects related to a supplementation with probiotics in order to prevent or reduce the incidence of infections onset in oral and respiratory tracts without any drugs-related adverse effects Bacterial vaginosis ( BV ) is the most prevalent vaginal infection worldwide and is characterized by depletion of the indigenous lactobacilli . Antimicrobial therapy is often ineffective . We hypothesized that probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 might provide an adjunct to antimicrobial treatment and improve cure rates .  Sixty-four Brazilian women diagnosed with BV were r and omly assigned to receive a single dose of tinidazole ( 2 g ) supplemented with either 2 placebo capsules or 2 capsules containing L. rhamnosus GR-1 and L. reuteri RC-14 every morning for the following 4 weeks . At the end of treatment ( day 28 ) , the probiotic group had a significantly higher cure rate of BV ( 87.5 % ) than the placebo group ( 50.0 % ) ( p = 0.001 ) . In addition , according to the Gram-stain Nugent score , more women were assessed with " normal " vaginal microbiota in the probiotic group ( 75.0 % vs. 34.4 % in the placebo group ; p = 0.011 ) . This study shows that probiotic lactobacilli can provide benefits to women being treated with antibiotics for an infectious condition
Overall , lactobacilli were beneficial for the treatment of patients with bacterial vaginosis .
No clear benefit was seen for c and idiasis or urinary tract infection .
In conclusion , the use of certain lactobacillus strains such as L. rhamnosus GR-1 and L. reuteri for prevention and treatment of recurrent urogenital infection is promising , especially for recurrent bacterial vaginosis .
Abstract Probiotics are increasingly being used to treat and prevent urogenital infections .
However , a critical assessment of their efficacy in major urogenital infections is lacking .
We report the results of a systematic review to determine the efficacy of probiotics for prevention or treatment of three major urogenital infections : bacterial vaginosis , vulvovaginal c and idiasis , and urinary tract infection .