Probiotics prophylaxis in infants with primary vesicoureteral reflux

Background: In this era of increasing bacterial resistance to antimicrobial therapy, probiotics have great potential and yet they are a harmless alternative approach. This study is a prospective randomized uncontrolled trial to investigate the preventive effect of probiotic prophylaxis in infants with primary vesicoureteral reflux (VUR) and frequently recurring urinary tract infection (UTI) during the first follow-up year.

Methods: One hundred and twenty-eight infants (aged 1 week to 12 months) with primary VUR were prospectively randomized into a probiotic (n = 64, Lactobacillus acidophilus, 1.0 × 10⁸ CFU/g) or antibiotic (n = 64, trimethoprim/sulfamethoxazole, 2/10 mg/kg) group.

Results: The incidence of recurrent UTI in the probiotic group was slightly lower than in the antibiotic group without statistical significance (32.8 % [21 out of 64] vs 40.6 % [26/64]) (P = 0.348). Causative organisms of recurrent UTI, resolution rate of VUR, and development of renal scarring were not different between the probiotic and antibiotic prophylaxis groups. The incidences of antibiotic resistance of causative organisms in recurrent UTI were significantly lower in the probiotic group than in the antibiotic group.

Conclusions: Probiotics could be considered a natural alternative regimen for prophylaxis in infants with primary VUR.