Are probiotics effective for preventing urinary tract infections in children?

In recent years, scholars have made a series of progress in the study of human symbiotic flora and human microbiome. Probiotics are a type of active microorganisms that are beneficial to the host. They are a general term for active beneficial microorganisms that colonize the human intestine and reproductive system and can produce definite health effects, thereby improving the host's microecological balance and playing a beneficial role. A certain number of probiotics can have a beneficial effect on the host's health [1, 2]. With the increasing clinical application of probiotics, scholars at home and abroad have conducted a number of clinical studies and formulated guidelines on probiotics [3,4,5].

Probiotics are composed of live microorganisms. Their mechanisms of action include maintaining mucosal barrier function, resisting invasion by colonizing bacteria, and inactivating bacterial toxins and pathogenic factors. A certain number of probiotics can have a beneficial effect on host health [6]. Research on the prevention and treatment of infectious diseases with probiotics has been carried out for several years, and some research results have shown that they have certain effects [7]. Urinary tract infections are characterized by a high recurrence rate and often require long-term use of antibiotics. Long-term anti-infection treatment may lead to microbial resistance and a decrease in antibacterial efficacy [8]. In previous studies, non-antibiotic preparations have been shown to benefit patients with urinary tract infections [9]. However, there is no clear conclusion on whether probiotics are effective in preventing urinary tract infections.

Modern microecological research has confirmed that intestinal flora plays a decisive role in the development and maturation of important physiological functions of children, such as immunity, metabolism, and nutrition. Intestinal flora is the original factor that drives the development and maturation of the immune system after birth and induces the balance of immune response. The role of intestinal flora on the immune system is multifaceted, and it has certain effects on innate immune response, adaptive immunity, mucosal immune system, and systemic immune system [10].

Garaiova et al. [11] gave 3-6-year-old children oral probiotics (including Lactobacillus acidophilus, Bifidobacterium, and Lactobacillus) combined with vitamin C for 6 months in a randomized, double-blind, placebo-controlled clinical trial. The results showed that the incidence of upper respiratory tract infection and the number of days of respiratory symptoms in the intervention group were significantly reduced, and the use of antibiotics, analgesics, cough suppressants, and nasal sprays due to illness was also less than that in the placebo group. In addition to its application in children with recurrent respiratory tract infections, in recent years, probiotics have made certain progress in the prevention and treatment of a variety of diseases such as childhood diarrhea [12,13], antibiotic-associated diarrhea [14], chemotherapy-associated diarrhea [15], neonatal necrotizing enterocolitis [16], and allergic diseases [17].

A study conducted a systematic review and meta-analysis on the preventive effect of probiotics on urinary tract infections in children. The results showed that the use of probiotics did not have a significant preventive effect, whether in the long term or short term, whether compared with antibiotics or placebo.

However, the study also has some limitations, including inconsistent diagnosis of urinary tract infection in each study; different age groups of children included in each study, which made it impossible to conduct further group analysis of children in that age group; inconsistent effectiveness indicators in each study; various types of probiotics in the experimental groups, and inconsistent dosing regimens; selective reporting of study results in one study as high risk, and high risk of data integrity in another RCT, which may have had a certain impact on the results. At the same time, there is still a lack of similar high-quality clinical trials in children.

In summary, based on the existing relevant research results, the role of probiotics in preventing urinary tract infections in children cannot be confirmed at present. At the same time, we look forward to the future development of standardized dosing regimens, standardized diagnostic criteria, long-term follow-up, high-quality, multi-subgroup (age group, probiotic variety, dosage, control group) and real-world studies targeting Asian children to further explore and verify the preventive role of probiotics in urinary tract infections in children.

References

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