Effectiveness of a Combination of Cranberries, Lactobacillus rhamnosus, and Vitamin C for the Management of Recurrent Urinary Tract Infections in Women: Results of a Pilot Study

doi:10.1016/j.eururo.2016.05.042

European Urology

Volume 70, Issue 6, December 2016, Pages 912-915

https://doi.org/10.1016/j.eururo.2016.05.042 Get rights and content

Abstract

Urinary tract infections (UTIs) are common in women and many patients with recurrent UTIs do not eradicate the condition albeit being treated with multiple courses of antibiotics. The use of nutritional supplements might reduce the risk of recurrent UTIs. However, the role of supplements taken as single agents appears to be limited. We hypothesized that a combination of cranberries, Lactobacillus rhamnosus, and vitamin C might produce a clinical benefit due to their additive or synergistic effects. We prospectively enrolled 42 consecutive women with recurrent UTIs treated with 120 mg cranberries (minimum proanthocyanidin content: 32 mg), 1 billion heat-killed L. rhamnosus SGL06, and 750 mg vitamin C thrice daily for 20 consecutive d. Patients were advised to stop taking these supplements for 10 d and then to repeat the whole cycle three times. Patients were contacted three mo and six mo following the end of the administration of these supplements and evaluated with a semistructured interview and urinalysis. Responders were defined as the absence of symptoms and negative urinalysis or urine culture. Follow-up data were available for 36 patients. Overall, 26 (72.2%) and 22 patients (61.1%) were responders at the 3-mo and 6-month follow-up. No major side effects were recorded. The administration of cranberries, L. rhamnosus, and vitamin C might represent a safe and effective option in women with recurrent UTIs.

Patient summary

We evaluated the effectiveness of cranberries, Lactobacillus rhamnosus, and vitamin C thrice daily for 20 consecutive d monthly for 3 mo for the management of recurrent urinary tract infections in women. Our results show that this approach might represent a safe and effective option.

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Cranberry and propolis combination was shown to be an interesting option to reduce recurrent UTIs [103]. A combination of cranberry, Lactobacillus rhamnosus, and vitamin C was found to safely and effectively treat recurrent UTI based on a pilot study [104]. One hundred and fifty women with UTIs due to E. coli were included in a randomized, blinded, and controlled trial with a 12-months follow-up.
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Two single extracts with different PACs composition were combined in the CB-B mixture to obtain a high content of PAC-A and a broad distribution of dimers-hexamers at once. In the URO-F formulation, CB-B was associated with D-mannose and ascorbic acid, two active compounds that represent an effective aid in urinary infection management (Kyriakides et al., 2020; Montorsi et al., 2016). Finally, the protective effects of CB-B and URO-F on both urothelial and intestinal epithelial cells were investigated.
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Urinary tract infections (UTIs) are the most common bacterial infections seen in the community, especially amongst females. The widespread use of antibiotics has led to the increased occurrence of E. coli resistant isolates worldwide. A promising non-antibiotic approach is the use of probiotic lactobacilli strains. This paper hypothesizes that Lactobacillus spp. containing products are able to prevent recurrent urinary tract infections in females. Using the keywords [lactobacillus OR lactobacilli OR probiotic] and [urinary tract infection OR UTI OR cystitis], a preliminary search on the PubMed, Ovid, Google Scholar and ClinicalTrials.gov database yielded 1,647 papers published in English between 1-Jan-1960 and 1-May-2017. 9 clinical trials with a total of 726 patients were reviewed. Different lactobacilli strains (in either oral or suppository formulation) were utilized and they demonstrated varying efficacy in the prevention of recurrent UTIs. Using a random-effects model, pooled risk ratio of at least one recurrent UTI episode during the entire study duration was 0.684 (95% CI 0.438 to 0.929, p < 0.001), per-protocol analysis. However, key limitations include significant inter-study variability and the limited duration of follow-up of most studies. Our hypothesis on the chemoprophylactic effects of probiotics for UTIs is plausible and supported by current data. Lactobacillus rhamnosus GR1 and Lactobacillus reuteri RC14 were the most commonly studied lactobacilli strains. Further and more robust randomized controlled trials with standardized lactobacilli strains and formulation are required for confirmation of effects.
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Brief CorrespondenceEffectiveness of a Combination of Cranberries, Lactobacillus rhamnosus, and Vitamin C for the Management of Recurrent Urinary Tract Infections in Women: Results of a Pilot Study

Abstract

Patient summary

Urology

J Urol

Nutr Res

Colloids Surf B Biointerfaces

J Clin Epidemiol

EAU Guidelines on Urological Infections

Recurrent urinary tract infections in women

Int Urogynecol J

Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women

Clin Infect Dis

Brief Correspondence
Effectiveness of a Combination of Cranberries, Lactobacillus rhamnosus, and Vitamin C for the Management of Recurrent Urinary Tract Infections in Women: Results of a Pilot Study