Antibiotic prophylaxis by low-dose cefaclor in children with vesicoureteral reflux

Area of Science:

• Pediatrics
• Infectious Diseases
• Pharmacology

Background:

• Recurrent urinary tract infections (UTIs) in children with vesicoureteral reflux (VUR) are often managed with prophylactic antibiotics like sulfamethoxazole/trimethoprim (SMX/TMP) and nitrofurantoin.
• Nitrofurantoin is unavailable in Japan, and increasing bacterial resistance to SMX/TMP raises concerns about its long-term effectiveness.
• Alternative prophylactic agents are needed to effectively manage pediatric VUR and prevent recurrent UTIs.

Purpose of the Study:

• To evaluate the efficacy and safety of low-dose cefaclor as a prophylactic agent for reducing recurrent UTIs in children diagnosed with primary VUR.
• To assess the rate of breakthrough UTIs and the development of bacterial resistance during cefaclor prophylaxis.

Main Methods:

• A study enrolled 39 children (31 male, 8 female) with primary VUR, aged 0.5 to 111 months.
• Children received a daily prophylactic dose of 5-10 mg/kg cefaclor, administered 1-3 times daily based on age.
• The mean duration of prophylactic treatment was 15.5 months, with urine samples tested for antibacterial activity.

Main Results:

• Eleven children (28.2%) experienced breakthrough UTIs during a total of 606 months of treatment, averaging one infection every 55 months.
• Bacterial resistance to cefaclor was observed in three organisms: Enterococcus spp., Morganella spp., and Pseudomonas spp.
• Antibacterial activity was confirmed in morning urine samples from all seven children tested, and cefaclor was well-tolerated with no adverse events leading to withdrawal.

Conclusions:

• Low-dose cefaclor appears to be a safe and effective alternative prophylactic treatment for reducing recurrent UTIs in children with VUR.
• The antibiotic demonstrated good patient compliance and a low rate of resistant Escherichia coli, suggesting its potential utility where other agents are unavailable or ineffective.