Annually, over one billion doses of probiotics are administered worldwide, and those administered for urogenital health have been well tolerated.[3]
In addition, the mouth, gastrointestinal tract, and female genitourinary tract are inhabited by Lactobacillus.[3]
Complications of endocarditis and bacteremia caused by lactobacilli are extremely rare. Most cases have occurred in patients with debilitating conditions that provide access to the bloodstream via a leaky gut.
Only 1.7% of 241 cases of bacteremia, endocarditis, and localized infections associated with Lactobacillus that were investigated by Cannon et al. were considered to have a possible link with heavy consumption of dairy products.[3]
Even so, the safety of probiotic use must be monitored and considered when doing clinical studies.
One factor to consider is the potential for transfer of antibiotic resistance, although it remains to be proven that probiotics have contributed in any way to drug resistance, or disease.
Rather, the overuse of antibiotics, especially in livestock feed and long-term prevention of infection remains a root cause of the increasing concerns over drug resistance.
Are Probiotics Worth It?
Antimicrobial treatment of urogenital infections is not always effective, and it is no surprise that alternative remedies are of interest..
Problems remain due to bacterial and yeast resistance, recurrent infections, as well as side effects.[3]
It is assumed that recurrences occur because antimicrobials fail to eradicate the pathogens, perhaps because of biofilm resistance, or that the virulent organisms come back from their source (the person's gut, or a sex partner) and attack when defenses are down.[3]
The reason for the lower diversity of microbes in the vaginal tract, compared to the colon, is still unclear, but may involve the receptivity of the vagina, different nutrient availability, and competition with pre-existing organisms.[3]
Lactobacilli have been demonstrated to dominate the normal vaginal environment.
They play a key role in determining the overall structure of the community and in providing protection against invasion by overt pathogens or against overgrowth by potentially pathogenic species among the normal flora through the production of hydrogen peroxide, bacteriocins, and lactic acid.[11]
The mechanisms through which lactobacilli function as anti-infective defenses, however, are still not fully understood.
This may involve production of antimicrobial factors, and maintenance of a vaginal pH of ≤4.5.
It could also be due to biosurfactants which alter the surrounding surface tension and reduce the ability of a wide range of pathogens to adhere.[3]
This might explain the relatively sparse coverage of epithelial cells by lactobacilli noted in healthy women.
In addition, lactobacilli have been shown to bind some pathogens, and this may be a means to block their adhesion, kill them through production of antimicrobials, and prevent their spread to other areas of the vagina and bladder.[3]
Probiotics Concluded
Research shows that probiotics are useful in preventing Candida, Bacterial Vaginosis and UTIs.
Unfortunately, for every scientifically-backed probiotic on the shelf of vitamin shops and drugstores, there are dozens of outwardly-similar products filled with questionable and even sometimes mislabeled organisms.
Most are probably harmless or ineffective, but some may contain antibiotic-resistant bacteria (as sometimes companies go so far as to state on the label)!
Since microbiologists know how readily resistance genes can spread from a probiotic to a person’s intestinal flora and from there to disease-causing organisms, there is a need to exercise caution, conduct research and find a reputable source for supplementation.
The amount of H2O2 produced by lactobacilli is important in establishing which species to use for vaginal health and this amount varies widely.
Quality supplements will disclose research-backed benefits and the specific strains contained in their products.
Because these products are not regulated by the FDA, it is important to choose a product with research and studies behind it.
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References
1. Bifodan. (2010). Clinical Benefits. Retrieved June 20, 2010, from EcoVag: http://www.ecovag.com/Clinical_Benefits-26.aspx
2. Bifodan. (2010). Probiotic Strains. Retrieved June 20, 2010, from EcoVag: http://www.ecovag.com/Probiotic_Strains-24.aspx
3. Cribby, S., Taylor, M., & Reid, G. (2008). Vaginal Microbiota and the Use of Probiotics. Interdisciplinary Perspective of Infectious Disease , 23-28.
4. Jarrow Formulas. (2006). FemDophilus. FemDophilus . Los Angeles, CA, USA: Jarrow Formulas.
5. Life Extension. (2010). Health Concerns Urinary Tract Infections. Retrieved May 25, 2010, from Life Extension: www.lef.org/protocols/prtcl-107.shtml
6. Reid, G., Burton, J., & Devillard, E. (2004, March 30). The Rationale for Probiotics in Female Urogenital Healthcare. Retrieved August 23, 2009, from WebMD: PMC1140735
7. Sachs, J. S. (2007). Good Germs, Bad Germs. New York: Hill and Wang.
8. State Key Laboratory for Moleclular Virology and Genetic Engineering. (2003). Main. Retrieved May 7, 2010, from Virulence Factors of Pathogenic Bacteria: www.mgc.ac.cn/VFs/main.htm
9. State Key Laboratory for Molecular Virology and Genetic Engineering. (2003). Escherichia. Retrieved May 7, 2010, from Virulence Factors of Pathogenic Bacteria: www.mgc.ac.cn/cgi-bin/VFs/genus.cgi?Genus=Escherichia
10. Vallor, A., Antonio, M., Hawes, S., & Hillier, S. (2001). Factors associated with acquisition of, or persistent colonization by, vaginal lactgobacillil: role of hydrogen peroxide production. Journal of Infectious Disease , 1431-6.
11. Vitali, B., Pugliese, C., Biagi, E., Candela, M., Turroni, S., Bellen, G., et al. (2007). Dynamics of Vaginal Bacterial Communities in Women Developing Bacterial Vaginosis, Candidiasis, or No Infection, Analyzed by PCR-Denaturing Gradient Gel Electrophoresis and Real-Time PCR. Applied Environmental Microbiology , 5731-5741.
12. Wilks, M., Wiggins, R., Whiley, A., Hennessy, E., Warwick, S., Porter, H., et al. (Feb. 2004). Identification and H2O2 Production of Vaginal Lactobacilli from Pregnant Women at High Risk of Preterm Birth and Relation with Outcome. Journal of Clinical Microbiology , 713-717. doi: 10.1128/JCM.42.2.713-717.2004.
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