Enlisting Probiotics to Combat Recurrent Urinary Tract Infections in Women—A Military Strategy for Meeting the Challenge

Author:

Watson Richard A.ORCID

Abstract

For decades, the potential role of probiotics in the prevention and treatment of recurrent urinary tract infections has been extensively studied. However, achieving an effective problem-solving strategy has thus far proven elusive. Perhaps adopting a military paradigm might expedite our assault on chronic, recurring bacteriuria in women. What is needed is a targeted strategy with specific attention to (1) the enemy: the case-specific uropathogen; (2) the battlefield: the extraordinarily complex interplay of factors within the bladder, unique to a given patient, which interface with profoundly important influences from the gut biome, as well as the vaginal biota; (3) the weapon: an antimicrobial probiotic with demonstrated activity against that specific uropathogen; (4) a new strategy: taking these complexities into account, we posit a key role for the instillation of case-specific lactobacilli directly into the bladder of the designated patient. This newly proposed, targeted intervention might be termed “Probiotic Intravesical Organic Therapy—PIVOT”; and (5) the long campaign: reaching clinically proven success may entail a long campaign. However, already, on many fronts, the elements necessary for victory recently seem to be falling into place.

Publisher

MDPI AG

Subject

Pharmacology (medical),Infectious Diseases,Microbiology (medical),General Pharmacology, Toxicology and Pharmaceutics,Biochemistry,Microbiology

Reference31 articles.

1. The Urinary Tract Microbiome in Health and Disease;Castillo;Eur. Urol. Focus,2018

2. “Urinary Tract Infection”—Requiem for a Heavyweight;Finucane;J. Am. Geriatr. Soc.,2017

3. Human Bacterial Repertoire of the Urinary Tract: A Potential Paradigm Shift;Morand;J. Clin. Microbiol.,2019

4. Deciphering the Urinary Microbiota Repertoire by Culturomics Reveals Mostly Anaerobic Bacteria from the Gut;Dubourg;Front. Microbiol.,2020

5. Probiotics for Preventing Urinary Tract Infections in Adults and Children;Schwenger;Cochrane Database Syst. Rev.,2015

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