SAN FRANCISCO, CA—Eradication of Quiescent Intracellular Reservoirs (QIRs) by combining ciprofloxacin + probiotic resulted in a decrease in recurrent urinary tract infections (UTIs), according to a report by Mehreen Arshad, MD, from Duke University Medical Center, Durham, NC, at IDWeek 2013.
Escheria coli (E. coli) invades the bladder epithelium and can form QIRs which can lead to recurrent infections. Rates of recurrence can be as high as 30% within the first 6 months after an initial infection in children. As a result, children with recurrent UTIs are often prescribed repeated courses of antibiotics making them prone to subsequent drug-resistant infections. A longer antibiotic therapy with a drug like a fluoroquinolone has been presumed to be more effective in eradicating the QIRS due to its ability to reach deep intracellular epithelium.
The Probiotic yeast Saccharomyces boulardii has been shown to reduce the intestinal burden of E. coli, which may act as another reservoir for recurrent infections.
Dr. Arshad and colleagues initiated a 14-day antibiotic + probiotic combination regimen to treat and prevent UTIs. Ten qualifying patients from the Duke University Medical Center’s pediatric infectious disease clinic that were treated with antibiotic-probiotic combination therapy for recurrent UTIs were identified. Their charts were retrospectively evaluated for confirmed diagnosis of recurrent UTI (>1 episode of a complicated or uncomplicated UTI within a year). Inclusion criteria included prior urologic evaluation, absence of predisposing conditions (eg, neurogenic bladder, VUR, spinal dysraphism), and follow up >3 months.
Participants were given ciprofloxacin 20mg/kg twice daily and 1 packet (250mg) of Saccharomyces boulardii daily for 1 year. Most of the patients had 5 episodes of UTI in the year prior to presentation. E. coli was the most common pathogen among the study population. The median follow up was 6 months, and 7 out of 10 patients were free of recurrent UTIs during the follow-up period.
Recurrent UTIs did not occur in 70% of the participants in this study. The study’s aim to decrease further ascending infection by using a probiotic resulted in a decrease in recurrent UTIs among all enrolled patients and was generally well tolerated. “Long-term effectiveness of this regimen needs to be further evaluated prospectively with a larger cohort of patients,” concluded Dr. Arshad and team.