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Antibacterial prophylaxis in children with urinary tract infection
1Department of Paediatrics, Sachs' Children's Hospital, Karolinska Institute, Stockholm, Sweden.
Insights
Conservative management of vesico-ureteric reflux using antimicrobial prophylaxis aims to prevent urinary tract infections and kidney scarring. However, studies evaluating its effectiveness are limited, highlighting the need for further research on optimal strategies and agents.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Conservative management of vesico-ureteric reflux often involves antimicrobial prophylaxis to prevent recurrent febrile urinary tract infections and subsequent renal scarring.
- Evaluating the efficacy of this strategy is challenging due to a lack of comparative studies and undefined optimal prophylaxis duration.
Purpose of the Study:
- To review the current landscape of antimicrobial prophylaxis for vesico-ureteric reflux.
- To identify gaps in research regarding the evaluation of prophylactic strategies, optimal treatment duration, and the influence of patient demographics (age, sex).
Main Methods:
- Literature review focusing on studies evaluating antimicrobial prophylaxis for vesico-ureteric reflux.
- Analysis of common prophylactic agents (nitrofurantoin, trimethoprim) and their associated challenges, including bacterial resistance and compliance.
- Identification of limitations in existing research, such as inadequate patient material definition and lack of randomized allocation.
Main Results:
- Antimicrobial prophylaxis is a common approach, but its effectiveness is not well-established due to study limitations.
- Nitrofurantoin and trimethoprim are frequently used, with trimethoprim associated with bacterial resistance.
- Break-through infections occur due to non-compliance and resistance.
Conclusions:
- Further research is needed to rigorously evaluate the effects of antimicrobial prophylaxis for vesico-ureteric reflux.
- Optimal prophylactic regimens, including duration and choice of agents, require further definition.
- Investigating alternative prophylactic agents and their ecological impact on microbial flora is recommended.
Abstract:
The aim, in conservative management of vesico-ureteric reflux by antimicrobial prophylaxis, is to prevent recurrent febrile urinary tract infections and consequent renal scarring. However, the effects of this prophylactic strategy are difficult to evaluate, since the required studies comparing children on prophylaxis with controls (without prophylaxis but under careful supervision) are lacking. Furthermore, the optimal length of prophylaxis needs to be defined. Since risk of renal scarring is believed to occur more frequently in young people, and since recurrent urinary infections mainly affect girls, the age and sex of subjects are important in the design of a prophylactic regimen. Nitrofurantoin and trimethoprim are the most common agents used for long-term, low-dose antibacterial prophylaxis. Break-through infections still result from non-compliance and from development of bacterial resistance, the latter mainly arising with trimethoprim. Few studies of prophylactic drugs are available that adequately define patient materials and include a random allocation to the different agents. Further studies of the effects of alternative prophylactic agents are called for, preferably combined with fresh insight into the ecological impact on the bowel and periurethral floras.