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[Urinary antimicrobial prophylaxis]
1Hôpital André-Mignot, 177, avenue de Versailles, 78150 Le Chesnay, France. sylvie.nathanson@wanadoo.fr
Insights
Antibiotics help prevent recurrent childhood urinary tract infections by killing bacteria and reducing their adhesion to the urinary tract lining. Further research is needed on their effectiveness, especially in children with vesico-ureteral reflux.
Area of Science:
- Pediatric infectious diseases
- Pharmacology
- Urology
Context:
- Recurrent urinary tract infections (UTIs), including cystitis and pyelonephritis, are common in children.
- Antibiotic prophylaxis is a standard preventive measure.
- The precise mechanisms of antibiotic action in UTI prevention are not fully elucidated.
Purpose:
- To review the prophylactic use of antibiotics for recurrent childhood UTIs.
- To discuss the known and potential mechanisms of action of commonly prescribed antibiotics.
- To highlight knowledge gaps, particularly concerning patients with vesico-ureteral reflux (VUR).
Summary:
- Antibiotics are employed to prevent recurrent pediatric UTIs, acting through bactericidal effects and potentially by inhibiting bacterial adhesion to the urothelium.
- Commonly used prophylactic agents include cotrimoxazole, trimethoprim, pivmecillinam, cefaclor, and nalidixic acid.
- Rigorous studies on the prophylactic efficacy of these agents are limited, with scarce data available for children with VUR.
Impact:
- Informs clinical practice regarding antibiotic selection and monitoring for pediatric UTI prevention.
- Identifies areas for future research to optimize prophylactic strategies.
- Contributes to understanding the role of bacterial adhesion in UTI pathogenesis and prevention.
Abstract:
Antibiotics are usually used to prevent childhood recurrent urinary tract infections: cystitis or pyelonephritis. The mechanism of action of these antibiotics, although imperfectly known, seems to be double: the antibiotic acts by its bactericidal effect, but also probably for minimal concentrations by reducing adhesion capability of bacteria to the urothelium. The most commonly used molecules are cotrimoxazole, trimethoprime, pivmecillinam, cefaclor and nalidixic acid. However all have not been studied rigorously as for their prophylactic capacity, and in particular very little is known for patients presenting with vesico-ureteral reflux.