Are you sure the probiotics you're taking can prevent urinary tract infections? Don't say you're already taking probiotics!

 

Previously mentioned were some methods to prevent recurrent urinary tract infections. 

Among them, the aspect of healthy food is of greatest concern to the public.

 

According to the treatment guidelines of the European Association of Urology, there are three types of healthy foods to try: cranberries, probiotics, and D-mannose. 

Whenever Dr. Huang mentions this, many people say, "But I'm already taking probiotics!"

 

As the saying goes, the devil is in the details. 

Not all probiotics can effectively prevent urinary tract infections. 

In fact, Dr. Huang's article initially mentioned the strains that current research considers to be the most effective. 

Here, once again, excerpts from the treatment guidelines of the European Association of Urology are provided and the key points are highlighted:

Most studies concluded that not all Lactobacillus strains are effective for vaginal flora restoration and rUTI prevention. 

The highest efficacy was shown with L. rhamnosus GR-1, L. reuteri B-54, L. reuteri RC-14, L. casei shirota, and L. crispatus CTV-05.

 

Therefore, when the public intends to purchase probiotics for preventing urinary tract infections, remember to pay special attention to whether they contain the above-mentioned strains.

References:

https://uroweb.org/guidelines/urological-infections/chapter/the-guideline

 

如何預防反覆泌尿道感染？How to prevent recurrent UTI？

 

1.生活習慣調整Behavioural modifications

 

比如多攝取水份，勿憋尿，性行為後應立刻排空膀胱並多喝開水，如廁後衛生紙由前往後擦拭，穿棉質褲...等。

 

事實上這些方法臨床證據有限，但有研究顯示，原本每天飲水量少於1.5升的停經前女性、若每天額外增加1.5升的水份攝取，能有效減少膀胱炎次數及抗生素使用量。

 

 

2.非抗生素類預防(Non-antimicrobial prophylaxis)：

 

a.停經後婦女補充外用雌激素(topical oestrogen therapy )

   (口服雌激素少數研究認為有效，但可能較易有全身性副作用)

 

b.免疫活性預防(Immunoactive prophylaxis)

在一些臨床研究顯示有效，台灣尚未引進

 

口服OM-89(Uro-Vaxom®)：18 種血清型熱滅活尿路致病性大腸桿菌提取物

 

熱滅活尿路致病菌的陰道栓劑(vaginal suppository containing ten strains of heat-killed uropathogenic bacteria )

 

MV140(Uromune)舌下疫苗(sublingual preparation of whole-cell inactivated bacteria)

 

StroVac去活尿路致病菌疫苗注射

 

c.補充益生菌（乳酸菌屬）probiotics (Lactobacillus spp.)

  目前研究認為最有效(highest efficacy)的菌株種類： L. rhamnosus GR-1, L. reuteri B-54, L. reuteri RC-14, L. casei shirota, and L. crispatus CTV-05

 

d.蔓越莓(cranberry)

雖然有關蔓越莓預防泌尿道感染的研究結果不盡相同(有些認為有效、有些則否)，

且無適當劑量和治療持續時間的明確臨床證據，

然而由於是食品對人體無害

推薦使用是目前的臨床共識。

 

e. 甘露糖(D-mannose)

總體來說研究證據質量仍不足，但有數筆研究認為甘露糖預防泌尿道感染的效果與抗生素相當。

 

f.膀胱灌注玻尿酸及硫酸軟骨素(Endovesical instillation hyaluronic acid and chondroitin sulphate)

有研究顯示能讓泌尿道感染發生率顯著降低，平均復發時間顯著延長，骨盆疼痛和尿急、頻尿顯著改善

 

g.四氮六甲環（馬尿酸烏洛托品）(Methenamine hippurate) 

考科藍(Cochrane)回顧研究認為可有效預防無腎臟異常患者的泌尿道感染，尤其是用於短期(一週或更短)預防時。

 

3.持續性低劑量抗生素預防及性行為後抗生素預防(Continuous low-dose antimicrobial prophylaxis and post-coital prophylaxis)

目前實證上預防感染復發最有效的方法。

 

 

 

資料來源：歐洲泌尿科醫學會治療指引

https://uroweb.org/guidelines/urological-infections/chapter/the-guideline