Chronic bacterial prostatitis (CBP) is a rare condition that causes recurring infections in the prostate and results in swelling, inflammation, and frequent urinary tract infections (UTIs).
Previous research has suggested that probiotics, in particular Lacobacillus strains, could modulate the infammatory pathway regulating the bowel infammatory status, suggesting a role in prostatic diseases, too. What's more, Vicari et al., documented that probiotics play a role in the management of patients affected by CBP and irritable bowel syndrome.
But no previous study has addressed the therapeutic role of Lactobacilli in the management of CBP while evaluating its role in the decrease of antibiotic use.
Therefore the purpose of the current research was to evaluate the efficacy of Lactobacillus paracasei CNCM I-1572 (L. casei DG by SOFAR) in both prevention of symptomatic recurrences and improvement of quality of life in 84 patients with CBP.
All patients were treated with antibiotics in agreement with EAU guidelines and then were treated with L. casei DG (2 capsules/day for 3 months). Clinical and microbiological analyses were carried out before and 6 months after the treatment. Analysis included NIH Chronic Prostatitis Symptom Index (CPSI), International Prostate Symptom Score (IPSS) and Quality of Well-Being (QoL) questionnaires.
Results suggest that the supplement reduced both the symptomatic recurrence and the use of antibiotics.
Tommaso Cai, the principal investigator, explains that the treatment of patients with CBP is currently based on the administration of antibiotics for long periods - about 4 or 6 weeks - and that may be the reason for intestinal bacterial flora modifications and development of bacterial resistances.
"Moreover, the imbalance in bowel microbiota could be the reason for recurrence and antimicrobial resistance. For this reasons, an antibiotic-sparing approach is urgently required for managing this kind of patients.
"Here, we focused our attention on the need for an antimicrobial-sparing approach in line with the principles of antimicrobial stewardship.
"This is significant as The World Health Organization reports that the antibiotic resistance is one of the biggest threats to global health, food security, and development today - it leads to longer hospital stays, higher medical costs and increased mortality."
Men aged 18-45 with CBP attending a single Urological Institution were enrolled in this phase IV study. All patients were treated with antibiotics in agreement with EAU guidelines and then were treated with L. casei DG (2 capsules/day for 3 months). Clinical and microbiological analyses were carried out before and 6 months after the treatment. Both safety and adherence to the treatment were evaluated 3 months after the enrolment.
NIH Chronic Prostatitis Symptom Index (CPSI), International Prostate Symptom Score (IPSS) and Quality of Well-Being (QoL) questionnaires were used. The outcome measures were the rate of symptomatic recurrence, changes in questionnaire symptom scores and the reduction of antibiotic use.
After 6 months, 61 patients (72.6%) reported a clinical improvement of symptoms with a return to their pre-symptom status. A time dependent improvement in clinical symptoms with significant changes in NIH-CPSI, IPSS and QoL, was also reported.
The team recorded that L. casei DG treatment induced a statistically significant decrease in both symptomatic recurrence (1.9/3 months vs 0.5/3 months) and antibiotic use (− 7938 UDD).
The report concludes: "Our results suggest that L. casei DG reduces both the symptomatic recurrence and the use of antibiotics. Therefore, the use of L. casei DG after antibiotic treatment represents a valid tool to improve the antibiotic stewardship in urological setting.
"In an economic perspective, our findings suggest a reduction in direct costs related to the reduction of antibiotic daily dose and indirect costs related to the patients’ well-being (less lost working days, less stress and anxiety), even if we did not re-evaluate this economic outcome."
Andrea Biffi, Chief Executive Officer of SOFAR S.p.A. told NutraIngredients: “This study demonstrated the efficacy of our strain L. casei DG in proctology, allowing SOFAR, one of the leading companies in the Microbiome research, to open a completely new and of huge interest research field for probiotics”
The researchers point out that the lack of control group and the possible placebo effect could be considered limitations of the study. They say larger clinical trials with a randomised and blinded design are needed to confrm these results especially in terms of economic perspectives.
Source: World Journal of Urology
Cai T et al.
"The use of Lactobacillus casei DG prevents symptomatic episodes and reduces the antibiotic use in patients afected by chronic bacterial prostatitis: results from a phase IV study"