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Long-term antibiotics for preventing recurrent urinary tract infection in children
1Children's Hospital at Westmead, Centre for Kidney Research, Locked Bag 4001, Westmead, NSW, Australia 2145. gabrieW4@chw.edu.au
Insights
Long-term antibiotics may reduce recurrent urinary tract infections (UTIs) in children, but evidence on their effectiveness and harms is limited. More research is needed to confirm benefits and safety for preventing pediatric UTIs.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Urinary tract infections (UTIs) are common in children, with potential for kidney damage.
- Recurrent UTIs necessitate preventative strategies, including long-term antibiotic use.
- Escherichia coli is the primary causative agent in over 80% of pediatric UTIs.
Purpose of the Study:
- To evaluate the efficacy of long-term antibiotic prophylaxis in preventing recurrent UTIs in children.
- To assess the associated harms and side effects of prolonged antibiotic use for UTI prevention.
Main Methods:
- Systematic review of randomized controlled trials comparing antibiotics with placebo or no treatment.
- Searched multiple databases (MEDLINE, EMBASE, CENTRAL) without language restrictions.
- Meta-analysis using a random-effects model to calculate relative risk and risk difference.
Main Results:
- Antibiotics demonstrated a reduction in repeat urine culture positivity compared to placebo (RR 0.44).
- Nitrofurantoin showed higher efficacy than trimethoprim but with more gastrointestinal side effects.
- Cefixime was less effective than nitrofurantoin and associated with a higher incidence of adverse reactions.
Conclusions:
- Current evidence suggests antibiotics may reduce recurrent UTIs, but with potential for side effects.
- The efficacy and harms of long-term antibiotic prophylaxis require further investigation.
- Large, robust, randomized, double-blind studies are essential for definitive conclusions.
Background:
Acute urinary tract infection (UTI) is common in children. By the age of seven 8.4% of girls and 1.7% of boys will have suffered at least one episode. Symptoms include fever, lethargy, anorexia, and vomiting. UTI is caused by Escherichia coli in over 80% of cases and treatment consists of a course of antibiotics. Due to acute illness caused by UTI and the risk of pyelonephritis-induced permanent kidney damage, many children are given long-term antibiotics aimed at preventing recurrence.
Objectives:
To determine the efficacy and harms of long-term antibiotics to prevent recurrent UTI in children.
Search Strategy:
We searched without language restriction MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, the Cochrane Renal Group's Specialised Register, reference lists of review articles and contacted content experts. Date of most recent search: January 2006
Selection Criteria:
Randomised comparisons of antibiotics with other antibiotics, placebo or no treatment to prevent recurrent UTI.
Data Collection And Analysis:
Two authors independently assessed and extracted information. A random-effects model was used to estimate relative risk (RR) and risk difference (RD) for recurrent UTI with 95% confidence intervals (CI).
Main Results:
Eight studies (618 children) were identified, five (406) comparing antibiotics with placebo/no treatment. The duration of antibiotic prophylaxis treatment varied from 10 weeks to 12 months. Compared to placebo/no treatment, antibiotics reduced the risk of repeat positive urine culture (RR 0.44, 95% CI 0.19 to 1.00; RD -30%, 95% CI -56% to -4%) No side effects were reported. One study reported that nitrofurantoin was more effective than trimethoprim in preventing recurrent UTI over a six month period (RR 0.48, 95% CI 0.25 to 0.92; RD -18%, 95% CI -34% to -3%). However, patients receiving nitrofurantoin were more likely to discontinue the antibiotic due to side effects (mainly gastrointestinal) (RR 3.17, 95% CI 1.36 to 7.37; RD 22%, 95% CI 8% to 36%). The other study found cefixime was more effective in preventing recurrent UTI than nitrofurantoin (RR 0.74, 95% CI 0.13 to 4.10; RD -3%, 95% CI -17% to -12%). However, 62% of patients receiving cefixime experienced an adverse reaction during the first six months of treatment (18/29) while only 26% (8/31) of patients receiving nitrofurantoin reported an adverse reaction.
Authors' Conclusions:
Large, properly randomised, double blinded studies are needed to determine the efficacy of long-term antibiotics for the prevention of UTI in susceptible children.
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