the efficacy of adjunctive probiotic therapy on treatment response in children with urinary tract infections: a randomized clinical trial

Background: urinary tract infections (utis) are among the most common bacterial infections in children. while antibiotics are the mainstay of treatment, issues such as recurrence and antibiotic resistance necessitate exploring adjunctive therapies. this study aimed to evaluate the impact of combining probiotics with antibiotics on treatment response and recurrence in pediatric utis.methods: in this randomized, parallel-group, single-center clinical trial, 60 children (aged 1 month to 18 years) with confirmed utis (positive urinalysis and urine culture) were enrolled. participants were randomly allocated to two groups: one received cefixime based on weight twice daily, and the other received the same cefixime regimen plus a daily probiotic (kidilact powder). urinalysis and urine culture were performed at baseline and followed up at one week, one month, two months, and three months after treatment initiation. the primary outcomes were the time to negative urine culture and the rate of uti recurrence.results: after one week, the combination therapy group showed a higher rate of negative urine cultures (86.7% vs. 70%, p = 0.117) and inactive urinalysis (73.3% vs. 63.3%, p = 0.405) compared to the antibiotic-only group, though these differences were not statistically significant. by two months, 100% of the combination group achieved negative results, compared to 96.7% in the antibiotic-only group. at the three-month follow-up, the recurrence rate was significantly lower in the combination therapy group (3.3%, 1/30) than in the antibiotic-only group (6.7%, 2/30).conclusion: adjunctive probiotic therapy with antibiotics may lead to a more rapid initial response and may reduce the recurrence of utis in children compared to antibiotic treatment alone. probiotics represent a promising complementary approach to managing pediatric utis. larger, double-blind, placebo-controlled trials with longer follow-up are needed to confirm these findings.