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Prophylactic antibiotics in children at risk for urinary tract infection
Stanley Hellerstein1, Ellen Nickell
1Section of Nephrology, The Children's Mercy Hospital, The University of Missouri School of Medicine at Kansas City, 2401 Gillham Road, MO 64108, USA. shellers@cmh.edu
Insights
Prophylactic antibiotics in children at risk for urinary tract infections (UTIs) showed breakthrough infections in girls. Voiding dysfunction and abnormal kidneys/VUR increased UTI risk during treatment and follow-up.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Urinary tract infections (UTIs) are common in children, with recurrent infections posing significant health risks.
- Prophylactic antibiotic use is a strategy to prevent UTIs in high-risk pediatric populations.
- Understanding risk factors associated with UTI recurrence during and after antibiotic prophylaxis is crucial for optimizing treatment.
Purpose of the Study:
- To evaluate the outcomes of prophylactic antibiotic use in children at risk for urinary tract infections (UTIs).
- To identify risk factors associated with UTI occurrence and recurrence during and after a period of suppressive antibiotic therapy.
- To inform future studies on the risks and benefits of prophylactic antibiotics in at-risk children.
Main Methods:
- A cohort of 66 children at risk for UTI received prophylactic antibiotics.
- Data collected included UTI occurrences during antibiotic treatment and a long-term follow-up (3.7+/-2.2 years).
- Statistical analysis (chi-square, risk estimate) identified factors associated with UTI development and recurrence.
Main Results:
- Breakthrough UTIs occurred in 13 girls but no boys during initial prophylaxis.
- During follow-up, 25 girls and 3 boys experienced recurrent UTIs.
- Voiding dysfunction and abnormal kidneys were significant risk factors during initial prophylaxis; voiding dysfunction and grade 3+ VUR were significant during follow-up.
Conclusions:
- Prophylactic antibiotics in at-risk children can lead to breakthrough infections, particularly in girls.
- Voiding dysfunction and significant renal abnormalities (abnormal kidneys, high-grade VUR) are key predictors of UTI risk.
- Further research is warranted to precisely define the risk-benefit profile of prophylactic antibiotics in pediatric UTI management.
Abstract:
The outcome of using prophylactic antibiotics in children considered at risk for a urinary tract infection (UTI) was documented in 66 children during the period of suppressive antibiotics and for a follow-up period of 3.7+/-2.2 years (range 0.92-9.83 years). A breakthrough UTI occurred in 13 girls but none of the boys during the initial course of prophylactic antibiotics. During the follow-up period, 33 girls and 5 boys had no recurrence of infection, while 25 girls and 3 boys had UTIs. Statistical analysis of the data using chi-square and risk estimate relating factors for infection to the occurrence of a UTI showed that during the period of initial prophylactic antibiotic there was significant risk of infection among children with voiding dysfunction and abnormal kidneys and during the follow-up there was increased risk of infection among those with voiding dysfunction and vesicoureteric reflux (VUR) of grade 3 or greater severity. Lesser grades of VUR and constipation did not significantly increase the risk of UTI. These observations should be useful in developing a study to define the risks and benefits of prophylactic antibiotic in "at-risk" children.