female uti

Probiotics Aid in Preventing Female Urinary Tract Infections

Dear EndoMune Subscribers,

Appropriately, May’s newsletter is directed to women. May was named for the Greek goddess Maia…and men, don’t forget that Sunday, May 13th, is Mother’s Day.

Let’s start this month’s newsletter with a case report:


Susan is a 48 year-old woman who has suffered with recurrent urinary tract infections. She was aware that the symptoms of urgency, frequency and burning are typical warnings signs of an impending urinary tract infection. Her doctor would likely prescribe an antibiotic to treat the infection.

Unfortunately, two years ago, Karen ended up in the emergency room with fever to 1030, generalized aches and hypotension. She was hospitalized and given IV antibiotics for a serious bout of an E. coli bacterial kidney infection.

Susan read about the benefits of taking a probiotic to lessen the risk of recurrent urinary tract infections. She emailed me to say that since starting EndoMune two years ago, she has not had another infection!!


The female urinary tract is composed of the kidneys, ureters, bladder and urethra.

The short female urethra places women at increased risk for urinary infections. A urinary tract infection or UTI is a bacterial infection that occurs when bacteria invade the urinary tract system. Nearly 1 in 3 women will have had at least 1 episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience 1 UTI during their lifetimes. Financially, the estimated annual cost of community-acquired UTI is significant, at approximately $1.6 billion1.


A urinary tract infection limited to the bladder can be painful and annoying. However, serious consequences can occur if a urinary tract infection spreads to the kidneys.

Susan’s recurrent infections occurred in the urinary bladder, or the cystitis. She was hospitalized because the bacteria were able to travel from the bladder to the kidneys and cause pyelonephritis, a serious kidney infection.


The urine is normally sterile. An infection occurs when bacteria are able to invade the lining cells of the urinary tract. The infection usually starts at the opening of the urethra and migrates into the urinary bladder and at times, up into the kidneys.

The culprit in at least 90% of uncomplicated infections is a type of bacteria called Escherichia coli, better know as E. coli. These bacteria normally live in the bowel (colon) and around the rectum.

These bacteria can accidentally contaminate the opening of the urethra and invade the lining cells of the urinary tract. Two common causes are limited fluid intake and sexual intercourse.


There have been many studies2,3 that have evaluated the benefits of probiotic bacteria like the Lactobacillus species in preventing recurrent UTI’s. Different strains have been used in clinical trials. Trials have included oral probiotics and vaginal suppositories. Not all the trials have shown benefit, but no study has found that probiotics cause any adverse effects.

The theory has been that the Lactobacillus bacteria that normally inhabit the vaginal mucosa produce different protective products that destroy or inhibit the invasion of harmful bacteria like E. coli.

Taking probiotics that contain Lactobacillus strains will increase the stool concentration of these protective bacteria. The Lactobacillus bacteria can then migrate from the intestinal tract to the urethra area, stimulating the lining cells to activate an immune response against pathogens like E. coli and producing a biofilm that acts as a barrier against harmful bacteria.


For women who suffer with recurrent infections, physicians recommend several preventive measures such as voiding after intercourse, wiping from front to back, and drinking plenty of water.

Physicians will prescribe an antibiotic for UTI’s and sometimes will recommend use of antibiotics as a preventative.


While there is no perfect regimen to prevent recurrent UTI’s, may assist with prevention. If you or a loved one suffers from recurrent UTI’s, consider trying a probiotic like EndoMune.

Remember, Mother’s Day is May 13th! Men, consider giving the mothers in your life a bottle of EndoMune.

Eat healthy, exercise, take EndoMune and live well!!

Dr. Hoberman

1) Epidemiology of urinary tract infections: incidence, morbidity, and economic costsBetsy Foxman, PhD, Am J Med. 2002 Jul 8;113 Suppl 1A:5S-13S

2) Prevention and treatment of urinary tract infection with probiotics: Review and research perspective.Borchert D, Sheridan L, Papatsoris A, Faruquz Z, Barua JM, Junaid I, Pati Y, Chinegwundoh F, Buchholz N.Indian J Urol. 2008   Apr;24(2):139-44

3) Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Stapleton AE,

Au-Yeung M, Hooton TM, Fredricks DN, Roberts PL, Czaja CA, Yarova-Yarovaya Y, Fiedler T, Cox M, Stamm WE.Clin Infect Dis. 2011 May;52(10):1212-7

Probiotics in the Medical News

Endomune Subscriber,

I am amazed by the number of new medical articles on probiotics. The scientific evidence of probiotic benefits keeps expanding.

In May 2012, two major medical journals published reports about the advantages of probiotics.

Why take a probiotic when prescribed an antibiotic?

A 53-year-old woman reports severe watery diarrhea with cramps. She is in her seventh day of a 10-day course of cefixime, which was prescribed for bronchitis.

Could the diarrhea have been prevented?

In the May 9th issue of Journal of the American Medical Association (JAMA), there was a report titled “Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea”(AAD).

When antibiotics are prescribed for infections like bronchitis, they can also destroy the healthy intestinal bacteria in the body. As a result, harmful bacteria can proliferate and cause diarrhea that ranges from mild to life-threatening.

The study reviewed 82 trials in which patients (adults and children) randomly received either an antibiotic alone or in combination with a probiotic.

A total of 11,811 studied patients were pooled together for the reviewed trials. The authors found that adding a probiotic when prescribing an antibiotic reduced the risk for diarrhea by 42%.

Take away message

Based on the results of this report, ask your health care provider if he/she would recommend a probiotic when prescribed an antibiotic. Remember to separate the time of taking an antibiotic and the probiotic by two hours. This will lower the risk of the antibiotic destroying the probiotic bacteria.

Can probiotics prevent urinary tract infections?

A 64-year old woman is on her third course of antibiotics for recurrent urinary tract infections. Unfortunately, the cultured E. coli bacteria are resistant to the antibiotic medication.

Was there anything else she could have tried?

In the May 14th issue of the Archives of Internal Medicine, a clinical trial2 was published titled “Lactobacilli vs Antibiotics to Prevent Urinary Tract Infections.”

Recurring UTIs are common among some women and low-dose antibiotics can sometimes prevent them. The worry is that overuse of the drugs also reduces their effectiveness by making disease-causing bacteria like E. coli resistant.

The authors conducted a controlled trial in 252 postmenopausal women with recurrent UTIs.

The randomized patients would receive a daily antibiotic or a probiotic containing Lactobacilli for one year.

The researchers then tracked how many UTIs occurred in each group of women over a year. They also collected vaginal swabs and samples of the women’s urine and feces every month to test for the presence of good bacteria and infection-causing bacteria like E. coli.

Over the year, the antibiotic group had an average of 2.9 UTIs per woman, and the probiotic group had an average of 3.3 UTIs. In the year prior to the study, the average number of recurrent UTIs was 7 in each group.

About 20 percent to 40 percent of E. coli in samples from all the women resisted the antibiotic at the beginning of the study. At 12 months between 80 percent and 95 percent of the bacteria resisted the drug in the women taking the antibiotic.

The resistance rate of the E. coli in the women taking the probiotic was slightly lower at one year compared to the start of the study. That is, the E. coli did not develop antibiotic resistance.

The authors concluded that taking a daily antibiotic was not any better than taking a probiotic in lessening recurrent rate of UTIs. “However, the development of antibiotic resistance is considerably lower with the use of lactobacillus. Therefore, lactobacilli may be an acceptable alternative for prevention of UTIs, especially in women who dislike taking antibiotics.”

Take away message

If you have recurrent UTIs, consider taking a probiotic containing Lactobacillus…like EndoMune.

Eat healthy, exercise, take EndoMune and live well!

Dr. Hoberman


1) Hempel,S PhD; Newberry,S PhD; Maher,A, MD; et al. Probiotics for the Prevention and Treatment of Antibiotic-Associated DiarrheaA Systematic Review and Meta-analysis JAMA. 2012;307(18):1959-1969. doi:10.1001/jama.2012.3507

2) Beerepoot MAJ, ter Riet G, Nys S, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012;172(9):ioi120011704-712

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