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Published on: September 21, 2015
Antibiotic prophylaxis in pediatric urology
Insights
Long-term antibiotic prophylaxis is commonly used for children with recurrent urinary tract infections (UTIs) or at risk for them. Further studies are needed, but it should be considered for high-risk infants and children.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Urinary tract infections (UTIs) are prevalent in infants and children.
- Children with risk factors like vesicoureteric reflux (VUR) often receive prophylactic antibiotics to prevent renal scarring and subsequent complications such as hypertension or end-stage renal disease.
- Recurrent UTIs, with or without VUR, are a primary indication for long-term antibiotic prophylaxis in pediatric populations.
Purpose of the Study:
- To review the current understanding of long-term antibiotic prophylaxis for preventing recurrent UTIs in infants and children.
- To highlight the lack of well-controlled, prospective studies evaluating the efficacy and necessity of this treatment strategy.
- To discuss the safety profile of commonly used prophylactic antibiotics and the need for further research.
Main Methods:
- Review of existing literature on antibiotic prophylaxis for UTIs in children.
- Analysis of the rationale behind current prophylactic practices, particularly for VUR and recurrent UTIs.
- Discussion of the safety and potential side effects of nitrofurantoin and trimethoprim/sulfamethoxazole in long-term pediatric use.
Main Results:
- Long-term antibiotic prophylaxis is a common practice for pediatric UTIs, especially in cases of VUR or recurrent infections.
- The efficacy and importance of this strategy have not been rigorously assessed through well-controlled, prospective studies.
- Commonly used prophylactic antibiotics like nitrofurantoin and trimethoprim/sulfamethoxazole are generally safe for long-term use in children, with serious side effects being rare and reversible.
Conclusions:
- Further prospective studies are essential to definitively evaluate the benefits of prophylactic antibiotics in preventing renal damage and complications in children with UTIs.
- Despite the lack of definitive evidence, long-term antibiotic prophylaxis remains a consideration for infants and children with risk factors until proven otherwise.
- The decision to use prophylactic antibiotics should be balanced against the need for more robust clinical evidence.
Abstract:
Urinary tract infection (UTI) is a common problem in infants and children. Children at risk for UTI such as vesicoureteric reflux (VUR) commonly receive prophylactic antibiotics to prevent renal scarring, which may lead to complications such as hypertension or end-stage renal disease. Recurrent UTI, with or without VUR, is the most common reason for long-term antibiotic prophylaxis in infants and children. However, the efficacy and importance of long-term antibiotic prophylaxis have not been assessed in well-controlled, prospective studies. Nitrofurantoin, trimethoprim/sulfamethoxazole have been used as prophylactic antibiotics for the prevention of UTI in children. Such medications are mostly safe in children for the long-term prophylactic therapy. Serious side effects are extremely rare and most are reversible with discontinuation of therapy. Although it is difficult to perform prospective studies in children and many factors are involved in the clinical course and prognosis of these patients, further studies are needed to evaluate the actual benefits of prophylactic antibiotics. Meanwhile, in infants and children with risk factors, long-term antibiotic prophylaxis should be considered, at least until there is evidence that these patients are not endangered by avoiding it.
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