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Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal

Marco Pennesi1, Laura Travan, Leopoldo Peratoner

  • 1Clinica Pediatrica, Istituto per l'Infanzia IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34100 Trieste, Italy. pennesi@burlo.trieste.it

Pediatrics
|May 21, 2008
PubMed

Insights

Continuous antibiotic prophylaxis did not prevent recurrent pyelonephritis or kidney scarring in young children with vesicoureteral reflux. This study found no benefit from long-term antibiotic use in this patient group.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Clinical Trials

Background:

  • Vesicoureteral reflux (VUR) in children often leads to recurrent pyelonephritis and potential renal scarring.
  • The efficacy of continuous antibiotic prophylaxis in preventing these outcomes remains debated, necessitating robust clinical trials.

Purpose of the Study:

  • To evaluate the effectiveness of continuous antibiotic prophylaxis in preventing recurrent pyelonephritis and new renal scars in children younger than 30 months with VUR.
  • To provide evidence-based guidance on long-term antibiotic management for pediatric VUR.

Main Methods:

  • A multicenter, open-label, randomized controlled trial involving 100 children (younger than 30 months) with VUR (grades II-IV) after a first pyelonephritis episode.
  • Participants were randomized to receive sulfamethoxazole/trimethoprim prophylaxis or no prophylaxis for 2 years, with a 4-year follow-up.
  • Outcomes assessed included pyelonephritis recurrence, renal scarring via imaging (cystourethrography, ultrasound, dimercaptosuccinic acid scans).

Main Results:

  • No significant difference in the recurrence rate of pyelonephritis between the antibiotic prophylaxis and control groups.
  • The incidence of renal scarring at the end of the 4-year follow-up was similar in both groups.
  • Baseline characteristics were comparable between the intervention and control groups.

Conclusions:

  • Continuous antibiotic prophylaxis is ineffective in reducing pyelonephritis recurrence in children with VUR.
  • Long-term antibiotic use does not prevent renal damage in this pediatric population.
  • Current findings challenge the routine use of antibiotic prophylaxis for VUR in children under 30 months.
Abstract

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