The Role of probiotic supplementation in reducing antibiotic-associated vaginal dysbiosis in women undergoing antibiotic treatment for urinary tract infections (Utis) at Wasit city

Background: Antibiotic therapy for urinary tract infections (UTIs) is known to disrupt the vaginal microbiota, leading to bacterial vaginosis (BV) and associated symptoms such as discharge, irritation, and odor. Probiotic supplementation with Lactobacillus strains has emerged as a promising strategy to prevent such dysbiosis. Objective: This randomized, double-blind, placebo-controlled clinical trial evaluated the effectiveness of oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 supplementation in reducing antibiotic-associated vaginal dysbiosis in women with UTIs. Methods: Fifty women aged 18-45 years were randomly allocated into two equal groups receiving either the probiotic supplement or a placebo alongside standard antibiotic therapy. Nugent scores, BV incidence, and self-reported vaginal symptoms were assessed at baseline, post-antibiotic, and follow-up using Gram-stain microscopy and clinical examination. Results: There were no significant differences in age (p = 0.506) or BMI (p = 0.797) between groups. At follow-up, Nugent scores remained significantly lower in the probiotic group (2.4 ± 1.6) compared to the placebo group (5.8 ± 2.1; p< 0.001). BV incidence was significantly reduced in the probiotic group post-antibiotic (8% vs. 40%, p = 0.020) and at follow-up (12% vs. 48%, p = 0.014). The prevalence of vaginal symptoms such as discharge, odor, and irritation was also significantly lower in the probiotic group (p< 0.05 for all comparisons). Multivariate regression confirmed a strong independent effect of probiotic use on both microbiota recovery and symptom reduction (p< 0.001). Conclusion: Probiotic supplementation during and after antibiotic therapy significantly reduced the risk of antibiotic-associated vaginal dysbiosis, BV incidence, and symptomatic discomfort in women undergoing UTI treatment. These findings support the integration of targeted probiotics as a preventive strategy in clinical settings.