1354. Use of an Antibiotic-Probiotic Combination to Treat Recurrent Urinary Tract Infections: A Pediatric Case-series
Session: Poster Abstract Session: Clinical Trials
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Urinary tract infection (UTI) is one of the most common bacterial infections in children. Recurrence can be as high as 30% after the initial episode. Uropathogenic bacteria, most commonly Escherichia coli (E.coli), invade the bladder epithelium and can form Quiescent Intracellular Reservoirs (QIRs) and may cause recurrent infections.  Traditional short courses of antibiotics fail to penetrate the uroepithelium and these QIRs may be spared. A longer duration of therapy with an agent such as a fluoroquinolone, which achieves high intracellular levels, has been postulated to be more effective in eradicating these QIRs. The probiotic yeast Saccharomyces boulardii has also been shown to reduce the intestinal burden of E. coli, which may be another reservoir for recurrent infections.   Thus, in pediatric recurrent UTIs (rUTIs), we have initiated an antibiotic-probiotic combination regimen to treat and prevent UTI. 


After Institutional Review Board approval, all patients evaluated in our pediatric infectious disease clinic for rUTIs and treated with an antibiotic-probiotic combination therapy were identified. Their charts were retrospectively evaluated for confirmation of a diagnosis of rUTI. Inclusion criteria included prior urologic evaluation, absence of predisposing conditions (e.g. neurogenic bladder) and follow up greater than 3 months.


Ten patients met the criteria for inclusion. Their median age was 8.5 years. No urologic abnormalities were identified. Most of the patients had 5 episodes of UTI in the year prior to presentation. E.coli was the most common pathogen among our cohort, although other gram negative bacteria were also identified in 6 of the 10 patients. The median follow up was 6 months. There were a total of 4 episodes of rUTI among 3 patients. No adverse events were reported.


QIR formation in the uroepithelium and ascending bladder infection from the intestinal tract are well described in the literature. Our strategy to eradicate the QIRs with a fluoroquinolone and decrease further ascending infection by using a probiotic resulted in a decrease in rUTI among all our patients and was well tolerated. The long term effectiveness of this regimen needs to be further evaluated prospectively with a larger cohort of patients.

Mehreen Arshad, MD, Ramiro Madden-Fuentes, MD, Sherry Ross, MD and Patrick Seed, MD, PhD, Duke University Medical Center, Durham, NC


M. Arshad, None

R. Madden-Fuentes, None

S. Ross, None

P. Seed, None

See more of: Clinical Trials
See more of: Poster Abstract Session

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.