Bovine colostrum for prevention of recurrent urinary tract infections in susceptible children: A randomized controlled trial.

Abstract

Background: Recurrent urinary tract infections (UTIs) in children with congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of deterioration of kidney functions and possibly, renal scarring. Rising antimicrobial resistance necessitates alternative preventive strategies. Bovine colostrum (BC), a bioactive prebiotic, has emerged as a promising adjuvant therapy in upper respiratory and gastrointestinal (GIT) infections. Given the shared mucosal immune mechanisms, the urinary tract may represent a suitable target for this preventive strategy to reduce UTI recurrence.

Aim: To evaluate the potential role of oral BC as an adjuvant therapy for preventing recurrent UTIs in children with CAKUT.

Methods: This randomized, double-blinded, placebo-controlled trial enrolled 60 children (< 18 years) with CAKUT and culture-confirmed recurrent UTIs. Children with urinary stones or endo-urinary devices were excluded. Participants were randomized to receive either oral BC sachets (n = 30) or placebo (n = 30) daily for one month. All patients were followed monthly for six months for UTI symptoms, physical examination, urine analysis, urine culture and sensitivity, complete blood count and C-reactive protein when indicated.

Results: The two study groups were comparable in age, sex, and chronic kidney disease stage (P > 0.05). Colostrum supplementation showed a nonsignificant reduction in the overall incidence of upper and lower UTIs vs placebo over six months [relative risk (RR) = 0.84, 95%CI: 0.63-1.12; P = 0.22]. However, significant reductions of 73%-75% in UTI incidence were observed during the fourth, fifth, and sixth months of follow up (P < 0.05 for each). When stratified by infection type, cystitis incidence was significantly lower in the colostrum group (43.3% vs 70.0%; RR = 0.62; 95%CI: 0.39-0.99; P = 0.037), while no significant difference was observed in pyelonephritis. GTI and respiratory infections were reduced by 34% (RR = 0.66; 95%CI: 0.50-0.87; P = 0.001). No allergic reactions were reported.

Conclusion: BC supplementation may reduce cystitis, as well as respiratory and GIT infections, in children with CAKUT. The observed month-specific reduction in UTIs suggests a possible cumulative benefit with continued supplementation, warranting further research.