Utilization of the Intestinal Tract as a Delivery System for Urogenital Probiotics Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Managing menopause. Effect of nonoxynol-9 gel on urogenital gonorrhea and chlamydial infection: a randomized controlled trial. Complementary and alternative medicine in gastroenterology: the good, the bad, and the ugly. Effect of a probiotic food as an adjuvant to triple therapy for eradication of Helicobacter pylori infection in children. Probiotics and prebiotics in gastrointestinal disorders World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics Assessing the evidence for the use of chiropractic manipulation in paediatric health conditions: A systematic review. Prophylactic Probiotics to Prevent Death and Nosocomial Infection in Preterm Infants Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 to prevent or cure bacterial vaginosis among women with HIV. Efficacy of low-dose intravaginal estriol on urogenital aging in postmenopausal women Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women.
Orally consumed viable bacteria with proposed beneficial health effects , the so-called probiotics , are increasingly used to treat disorders of the gastrointestinal tract . It has been recently suggested that specifically selected lactobacilli could have a therapeutic role in female urogenital tract infections . It has been also suggested that some of these bacteria could be not intravaginally instilled , but also orally delivered . The authors investigate the ability of lactobacilli isolated from the vagina to survive gastrointestinal tract transit , and establish a link between the rate of intestinal survival and vaginal colonization Bacterial vaginosis ( BV ) is particularly common in black women , and in Nigeria it is often caused by Mycoplasma , as well as Atopobium , Prevotella and Gardnerella sp. Antimicrobial metronidazole oral therapy is poorly effective in eradicating the condition and restoring the Lactobacillus microbiota in the vagina . In this study , 40 women diagnosed with BV by discharge , fishy odor , sialidase positive test and Nugent Gram stain scoring , were r and omized to receive either two dried capsules containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 each night for 5 days , or 0.75 % metronidazole gel , applied vaginally twice a day ( in the morning and evening ) . Follow-up at day 6 , 15 and 30 showed cure of BV in significantly more probiotic treated subjects ( 16 , 17 and 18/20 , respectively ) compared to metronidazole treatment ( 9 , 9 and 11/20 : P=0.016 at day 6 , P=0.002 at day 15 and P=0.056 at day 30 ) . This is the first report of an effective ( 90 % ) cure of BV using probiotic lactobacilli . Given the correlation between BV and HIV , and the high risk of the latter in Nigeria , intravaginal use of lactobacilli could provide women with a self-use therapy , similar to over-the-counter anti-yeast medication , for treatment of urogenital infections OBJECTIVE To provide up date d guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease , breast cancer , urogynaecology , and sexuality . OUTCOMES Lifestyle interventions , prescription medications , and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms . Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are review ed . Approaches to the identification and evaluation of women at high risk of osteoporosis , along with options for prevention and treatment , are presented in the companion osteoporosis guideline . EVIDENCE Published literature was retrieved through search es of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary ( e.g. , hormone therapy , menopause , cardiovascular diseases , and sexual function ) and key words ( e.g. , hormone therapy , perimenopause , heart disease , and sexuality ) . Results were restricted to clinical practice guidelines , systematic review s , r and omized control trials/controlled clinical trials , and observational studies . Results were limited to publication date s of 2009 onwards and to material in English or French . Search es were up date d on a regular basis and incorporated in the guideline until January 5 , 2013 . Grey ( unpublished ) literature was identified through search ing the websites of health technology assessment and health technology assessment -related agencies , national and international medical specialty societies , and clinical practice guideline collection CONTEXT Nonoxynol-9 has been suggested as a vaginal microbicide to protect against common sexually transmitted infections . OBJECTIVE To compare nonoxynol-9 gel and condom use ( gel group ) vs condom use alone ( condom group ) for the prevention of male-to-female transmission of urogenital gonococcal and chlamydial infection . DESIGN AND SETTING R and omized controlled trial conducted at 10 community clinics and 10 pharmacies in Yaoundé , Cameroon , between October 1998 and September 2000 , with 6 months of follow-up . PARTICIPANTS High-risk population of 1251 women ( excluding sex workers ) being treated for or who had symptoms of sexually transmitted infections . Three were excluded from the gel group ( 0.5 % ) and 7 from the condom group ( 1 % ) because of no follow-up data . INTERVENTIONS Nonoxynol-9 gel ( 100 mg ) and condoms or condoms only . MAIN OUTCOME MEASURE A positive test result for gonococcal or chlamydial infection by the ligase chain reaction assay ; secondary outcome measure was a positive test result for human immunodeficiency virus ( HIV ) . RESULTS The rate ratio ( RR ) for new urogenital infections was 1.2 for the gel group vs condom group ( 95 % confidence interval [ CI ] , 0.9 - 1.6 ; P = .21 ) . The gel group had 116 diagnosed gonococcal infections , chlamydial infections , or both for a rate of 43.6 per 100 person-years , and the condom group had 100 infections for a rate of 36.6 per 100 person-years . The RR for gonococcal infection in the gel group vs the condom group was 1.5 ( 95 % CI , 1.0 - 2.3 ) and for chlamydial infection was 1.0 ( 95 % CI , 0.7 - 1.4 ) . There were 5 new cases of HIV infections in the gel group and 4 in the condom group . Three women in each group became pregnant during the study . CONCLUSION Nonoxynol-9 gel did not protect against urogenital gonococcal or chlamydial infection A large proportion of the American population avails itself of a variety of complementary and alternative medicine ( CAM ) interventions . Allopathic practitioners often dismiss CAM because of distrust or a belief that there is no sound scientific evidence that has established its utility . However , although not widely appreciated , there are thous and s of r and omized controlled trials ( RCTs ) that have addressed the efficacy of CAM . We review ed the RCTs of herbal and other natural products , acupuncture , and homeopathy as examples of typical CAM modalities , focusing on conditions of interest to gastroenterologists . Peppermint ( alone or in combination ) has supportive evidence for use in patients with dyspepsia , irritable bowel syndrome , and as an intraluminal spasmolytic agent during barium enemas or endoscopy . Ginger appeared to be effective in relieving nausea and vomiting due to motion sickness or pregnancy . Probiotics were useful in childhood diarrhea or in diarrhea due to antibiotics ; one particular formulation ( VSL#3 ) prevented pouchitis . Acupuncture appeared to ameliorate postoperative nausea and vomiting and might be useful elsewhere . There is even a suggestion that homeopathy has efficacy in treatment of gastrointestinal problems or symptoms . The major problem in interpreting these CAM data is the generally low quality of the RCTs , although that quality might not be different compared to RCTs in the general medical literature . Gastroenterologists should become familiar with these techniques ; it is likely that their patients already are OBJECTIVE Current recommendations for treatment of Helicobacter pylori infection include a proton pump inhibitor in combination with two antibiotics . We evaluated the potential activity of a probiotic food as an adjuvant to antibiotic triple therapy for eradication of H. pylori infection in children from Buenos Aires , Argentina . METHODS Sixty-five children who tested positive for H. pylori , as diagnosed by (13)C-urea breath test and endoscopy , were included in this study . Patients were r and omized to receive 1-wk triple therapy plus probiotic food ( treated group ) or milk placebo ( control ) that was administered for 3 mo . Probiotic food consisted of 250 mL of a commercial yogurt containing Bifidobacterium animalis and Lactobacillus casei ( 10(7 ) colony-forming units/mL ) . Post-treatment urea breath test controls were performed 1 and 3 mo after the end of triple therapy . RESULTS We found no significant differences in H. pylori eradication rates ( ERs ) at 1 and 3 mo between the treated group ( ER = 45.5 % and 42.4 % ) and the control group ( ER = 37.5 % and 40.6 % ) . Relative risks between groups were 0.87 ( 95 % confidence interval 0.58 - 1.32 , P = 0.345 ) in the first month and 0.97 ( 95 % confidence interval 0.64 - 1.46 , P = 0.542 ) in the third month . CONCLUSIONS We could not demonstrate an adjuvant effect of the studied probiotic food to triple therapy in the eradication of H. pylori infection in children in Buenos Aires , Argentina . However , we found lower ERs than those reported for the same therapeutic scheme in developed countries , indicating that bacterial resistance and alternative therapeutic strategies should be studied Purpose of review This review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect . Recent findings The demonstration that immune and epithelial cells can discriminate between different microbial species has extended the known mechanism(s ) of action of probiotics beyond simple barrier and antimicrobial effects . It has also confirmed that probiotic bacteria modulate mucosal and systemic immune activity and epithelial function . The progressive unraveling of these mechanisms of action has led to new credence for the use of probiotics and prebiotics in clinical medicine . Level I evidence now exists for the therapeutic use of probiotics in infectious diarrhea in children , recurrent Clostridium difficile – induced infections and postoperative pouchitis . Level II evidence is emerging for the use of probiotics in other gastrointestinal infections , prevention of postoperative bacterial translocation , irritable bowel syndrome , and in both ulcerative colitis and Crohn disease . Nevertheless , one consistent feature has emerged over the past year : Not all probiotic bacteria have similar therapeutic effects . Future clinical trials will need to incorporate this fact into trial planning and design . Summary The use of probiotics and prebiotics as therapeutic agents for gastrointestinal disorders is rapidly moving into the “ mainstream . ” Mechanisms of action explain the therapeutic effects and r and omized ; controlled trials provide the necessary evidence for their incorporation into the therapeutic armamentarium Background Prevalence of  allergic diseases in infants , whose parents and siblings do not have allergy , is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative . Intestinal microbiota may modulate immunologic and inflammatory systemic responses and , thus , influence development of sensitization and allergy . Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention . Objective The World Allergy Organization ( WAO ) convened a guideline panel to develop evidence -based recommendations about the use of probiotics in the prevention of allergy . Methods We identified the most relevant clinical questions and performed a systematic review of r and omized controlled trials of probiotics for the prevention of allergy . We followed the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach to develop recommendations . We search ed for and review ed the evidence about health effects , patient values and preferences , and re source use ( up to November 2014 ) . We followed the GRADE evidence -to-decision framework to develop recommendations . Results Currently available evidence does not indicate that probiotic supplementation  reduces the risk of developing allergy in children . However , considering all critical outcomes in this context , the WAO guideline panel determined that there is a likely net benefit from using probiotics result ing primarily from prevention of eczema . The WAO guideline panel suggests : a ) using probiotics in pregnant women at high risk for having an allergic child ; b ) using probiotics in women who breastfeed infants at high risk of developing allergy ; and c ) using probiotics in infants at high risk of developing allergy . All recommendations are conditional and supported by very low quality evidence . Conclusions WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents , clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding , and whether to give them to infants OBJECTIVE To review the biomedical literature up to and including 2003 , and determine the extent of the evidence related to the therapeutic application of chiropractic manipulation for paediatric health conditions . No critical appraisal of the evidence is undertaken . DATA SOURCES The indexed manual therapy sector including medical , chiropractic , physiotherapy , naturopathic and osteopathic literature was search ed . This included PubMed ; the Manual , Alternative , and Natural Therapy Index System ; the Cumulative Index to Nursing and Allied Health Literature ; the Index to Chiropractic Literature ; the Paediatric Economic Data base Evaluation Project ; the Cochrane Library ; the Canadian Coordinating Office for Health Technology Assessment data base ; and the Agency for Healthcare Research and Quality data base . Other re sources included research conference and symposium proceedings , and the references of identified studies . RESULT The search identified 1731 articles , of which 166 met the eligibility criteria . Two review ers determined by consensus each citation 's appropriate level on the strength of evidence scale . There was one systematic review , nine r and omized controlled trials , one observational study , 141 descriptive case studies and 14 conference abstract s. SUMMARY Health cl aims made by practitioners regarding the application of chiropractic manipulation as a health care intervention for paediatric health conditions are , for the most part , supported by low levels of scientific evidence . Chiropractors , in particular , employ manipulation for the treatment of a wide variety of paediatric health conditions . The evidence rests primarily with clinical experience , descriptive case studies and a few r and omized controlled trials . There is a need for more rigorous scientific inquiry to examine the value of manipulative therapy in the treatment of paediatric conditions . To advance the health interests of paediatric patients , health care decisions made on the basis of expert opinion or clinical experience must integrate the best research evidence available from high- quality , scientific studies BACKGROUND AND OBJECTIVE : It has been suggested that probiotics may decrease  infant mortality and nosocomial infections because of their ability to suppress colonization and translocation of bacterial pathogens in the gastrointestinal tract . We design ed a large double-blinded placebo-controlled trial using Lactobacillus reuteri to test this hypothesis in preterm infants . METHODS : Eligible infants were r and omly assigned during the first 48 hours of life to either daily probiotic administration or placebo .  Infants in the intervention group were administered enterally 5 drops of a probiotic preparation containing 108 colony-forming units of L reuteri DSM 17938 until death or discharge from the NICU . RESULTS : A total of 750 infants ≤2000 g were enrolled . The frequency of the primary outcome , death , or nosocomial infection , was similar in the probiotic and placebo groups ( relative risk 0.87 ; 95 % confidence interval : 0.63–1.19 ; P = .376 ) . There was a trend toward a lower rate of nosocomial pneumonia in the probiotic group ( 2.4 % vs 5.0 % ; P = .06 ) and a nonsignificant 40 % decrease in necrotizing enterocolitis ( 2.4 % vs 4.0 % ; P = .23 ) . Episodes of feeding intolerance and duration of hospitalization were lower in infants ≤ 1500 g ( 9.6 % vs 16.8 % [ P = .04 ] ; 32.5 days vs 37 days [ P = .03 ] ) . CONCLUSIONS : Although L reuteri did not appear to decrease the rate of the composite outcome , the trends suggest a protective role consistent with what has been observed in the literature . Feeding intolerance and duration of hospitalization were decreased in premature infants ≤1500 OBJECTIVE To assess , among women with HIV , whether long-term oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 supplementation can prevent bacterial vaginosis ( BV ) and enhance the cure rate of metronidazole  among those with BV . METHODS A r and omized , double-blind , placebo-controlled trial conducted among 65 HIV-infected women with an aberrant microbiota ( Nugent score 4 - 10 ) who were r and omized to receive daily probiotics or placebo for 6 months . Those with BV ( Nugent score 7 - 10 ) additionally received metronidazole for 10 days ( 400 mg twice daily ) . RESULTS We did not find an enhanced cure rate of BV among women with HIV treated with adjuvant probiotics to metronidazole treatment . Among women with an intermediate vaginal flora , probiotics tended to increase the probability of a normal vaginal flora ( odds ratio 2.4 ; P=0.1 ) and significantly increased the probability of a beneficial vaginal pH ( odds ratio 3.8 ; P=0.02 ) at follow-up . CONCLUSION Supplementation of probiotic L. rhamnosus GR-1 and L. reuteri RC-14 did not enhance the cure of BV among women living with HIV , but may prevent the condition among this population . TRIAL REGISTRATION NCT00536848 Objective To assess the efficacy and safety of intravaginal estriol administration on  urinary incontinence , urogenital atrophy , and recurrent urinary tract infections in postmenopausal women . Design Eighty-eight postmenopausal women with urogenital aging symptoms were enrolled in this prospect i ve , r and omized , placebo-controlled study . Participants were r and omly divided into two groups , with each group consisting of 44 women . Women in the treatment group received intravaginal estriol ovules : 1 ovule ( 1 mg ) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy . Women in the control group received inert placebo vaginal suppositories in a similar regimen . We evaluated urogenital symptomatology , urine cultures , colposcopic findings , urethral cytologic findings , urethral pressure profiles , and urethrocystometry before as well as after 6 months of treatment . Results After therapy , the symptoms and signs of urogenital atrophy significantly improved in the treatment group in comparison with the control group . Thirty ( 68 % ) of the treated participants , and only seven ( 16 % ) of the control participants registered a subjective improvement of their incontinence . In the treated participants , we observed significant improvements of colposcopic findings , and there were statistically significant increases in mean maximum urethral pressure , in mean urethral closure pressure as well as in the abdominal pressure transmission ratio to the proximal urethra . Urethrocystometry showed positive but not statistically significant modifications . Conclusions Our results show that intravaginal administration of estriol may represent a satisfactory therapeutic choice for those postmenopausal women with urogenital tract disturbances who have contraindications or refuse to undergo st and ard hormone therapy Urogenital infections afflict an estimated one billion people each year . The size of this problem and the increased prevalence of multi-drug resistant pathogens make it imperative that alternative remedies be found . A r and omized , placebo-controlled trial of 64 healthy women given daily oral capsules of Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 for 60 days showed no adverse effects . Microscopy analysis showed restoration from asymptomatic bacterial vaginosis microflora to a normal lactobacilli colonized microflora in 37 % women during lactobacilli treatment compared to 13 % on placebo ( P=0.02 ) . Lactobacilli were detected in more women in the lactobacilli-treated group than in the placebo group at 28 day ( P=0.08 ) and 60 day ( P=0.05 ) test points . Culture findings confirmed a significant increase in vaginal lactobacilli at day 28 and 60 , a significant depletion in yeast at day 28 and a significant reduction in coliforms at day 28 , 60 and 90 for lactobacilli-treated subjects versus controls . The combination of probiotic L. rhamnosus GR-1 and L. fermentum RC-14 is not only safe for daily use in healthy women , but it can reduce colonization of the vagina by potential pathogenic bacteria and yeast
Probiotic interventions were effective for treatment and prevention of BV , prevention of recurrences of c and idiasis and UTIs , and clearing HPV lesions .
Although clinical practice recommendations were limited by the strength of evidence , probiotic interventions were effective in treatment and prevention of urogenital infections as alternatives or co-treatments .
INTRODUCTION Probiotics are a complementary and integrative therapy useful in the treatment and prevention of urogenital infections in women .
This study extends the work of research ers who systematic ally investigated the scientific literature on probiotics to prevent or treat urogenital infections .