A study protocol has caught my eye this week, a trial of oral probiotics vs placebo as prophylaxis for UTI in spinal cord patients, a very high risk group for these infections and associated complications. It will be a multi-site randomised double-blind double-dummy placebo-controlled factorial design study running over 24 weeks conducted in New South Wales, Australia. Probably about as robust as it gets scientifically.The authors cite a review from 10 years ago that suggested that restoration of the female vaginal flora may have beneficial effects in reducing recurrent UTIs, noting that probiotics have an excellent safety profile. In a landmark recommendation the authors recommended further studies be done.. Sadly not many have been published. I will look forward to the publication of the results of this study (whichever way it goes) with some interest, particularly those relating to MDRO colonisation, for which this is a high-prevalence group. Although the primary outcome of interest is the prevention of UTI, a number of the secondary outcomes are also of interest, including how probiotic intervention affects microbial community composition in the urine and urinary catheter and what are the differences between microbial communities in individuals who are symptomatic versus asymptomatic for UTI. The biofilms present in the catheters will also be examined and I hope that the authors will also examine encrustation and blockage when they consider this aspect of the work. Anything that has the potential to reduce the burden of antibiotic use should be seriously looked at, especially if follow-up work could look more widely at long-term catheters, a hugely understudied area.