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Antibiotic prophylaxis for children at risk of developing urinary tract infection: a systematic review
Rintaro Mori1, Anita Fitzgerald, Craig Williams
1National Collaborating Centre for Women's and Children's Health, London, UK. rintaromori@gmail.com
Insights
Prophylactic antibiotics do not prevent recurrent urinary tract infections (UTIs) or kidney scarring in children. Routine antibiotic use is not recommended for children at risk of UTIs.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Antibiotic prophylaxis is commonly used in children post-urinary tract infection (UTI) to prevent recurrence.
- The practice aims to reduce renal scarring by preventing acute pyelonephritis.
Purpose of the Study:
- To evaluate the effectiveness of antibiotic prophylaxis in preventing recurrent UTIs and renal scarring in children.
- To synthesize evidence from randomized controlled trials on antibiotic prophylaxis in pediatric UTI management.
Main Methods:
- Systematic review and meta-analysis of eight randomized controlled trials.
- Searched Medline, EMBASE, Cochrane Library, and CINAHL for relevant studies.
- Included children with symptomatic UTI and those with vesico-ureteric reflux.
Main Results:
- No significant difference in symptomatic UTI recurrence between antibiotic prophylaxis and control groups (RR 0.96).
- No significant difference in new or progressive renal scarring (RR 1.15).
- Analysis included 677 children across eight trials.
Conclusions:
- Lack of evidence supporting the positive benefit of prophylactic antibiotics for children at risk of UTIs.
- Routine use of prophylactic antibiotics in this pediatric population is not recommended.
Background:
Antibiotic prophylaxis in children who have had urinary tract infection (UTI) to prevent further infection is a common practice. The aim of this study is to reduce the development of further renal scarring by the prevention of recurrent acute pyelonephritis.
Methods:
A systematic review of randomized controlled trials assessing effectiveness of antibiotic prophylaxis in children who have recovered from a symptomatic UTI and children in whom vesico-ureteric reflux has been identified independent of a history of acute UTI was carried out by systematic search in Medline, EMBASE, the Cochrane Library and CINAHL using keywords and thesaurus terms. Identified trials were independently appraised by two researchers. Data were extracted and synthesized in meta-analyses.
Results:
A total of 677 children in eight trials were included in the analyses. There was no evidence of difference on meta-analysis of all the included studies, or any of the four subgroups, between the intervention and control groups in recurrence of symptomatic UTI [four trials, RR 0.96 (95% CI: 0.69-1.32]) and incidence of new or progressive renal scarring [four trials, overall RR 1.15 (95% CI: 0.75-1.78)].
Conclusion:
Given the lack of evidence on positive benefit of using prophylactic antibiotics for children at risk of developing UTI, routine use of antibiotics for these children is not recommended.
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