Probiotics have become increasingly popular among Americans. Between 2007 and 2012, the number of Americans taking a probiotic supplement increased four-fold to nearly 3 million adults and 294,000 children for different indications including recurrent urinary tract infection (UTI). Here, we review the literature on probiotic efficacy in recurrent UTI and examine the available products on the market in order to help urologists discuss probiotics with their patients.

In order to broadly sample the most popular available products, we evaluated the 40 top probiotics on Amazon.com, excluding duplicates, and also the generic products from the 3 most popular pharmacies in the USA: CVS, Walgreens, and Walmart. For each probiotic we reviewed the strains, colony forming units (CFUs), indication, demographic, and monthly cost, and compared our findings to strains shown to be effective in the literature.

A total of 46 products were identified. 40/46 (86.9%) contained Lactobacillus spp., with 30/46 (65.2%) containing L. acidophilus. 18/46 (39.1%) of products contained B. lactis, 4/46 (8.6%) included L. reuteri. Only 1/46 (2.2%) product included L. rhamnosus GR-1. Prices ranged from $1.8/month to $36.3/month, with an average cost of $14.85/month. The dose of the probiotics ranged from 0.1 billion CFUs to 50 billion CFUs, with most being one (36/46) or two (6/46) doses daily, and with a mean dose of 12.1 billion CFUs. Most products were marketed for GI health (39/46, 84.7%), and immunity (33/46, 71.7%), some were also indicated for vaginal health (5/46, 10.8%) and genitourinary wellbeing (3/46, 6.5%).

Despite contradictory data on usefulness of probiotics in recurrent UTIs, their consumption is dramatically increasing. Most of the commercially available products contain at least Lactobacilli, however, fewer contain more specific strains that have some evidence of benefit for recurrent UTI such as L. acidophilus, B. lactis, L. reuteri and L. rhamnosus GR-1. In addition, probiotics have been shown to have an excellent safety and adverse effect profile.

Urologists should advise patients to take probiotics containing more effective strains, and should also consider the cost in their recommendations as it varies widely, especially because most probiotics are taken indefinitely.