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Nitrofurantoin versus trimethoprim prophylaxis in recurrent urinary tract infection in children. A randomized,
L Brendstrup1, K Hjelt, K E Petersen
1Department of Paediatrics, Hillerød Hospital, University of Copenhagen, Denmark.
Insights
Nitrofurantoin is more effective than trimethoprim for preventing recurrent urinary tract infections (UTIs) in children with urinary tract abnormalities. Trimethoprim prophylaxis led to increased antibiotic resistance and different bacterial patterns without improving recurrence rates.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Recurrent urinary tract infections (UTIs) are a common pediatric concern.
- Prophylactic antibiotic use is a strategy to prevent recurrent UTIs, but optimal drug choice and impact on resistance require evaluation.
Purpose of the Study:
- To compare the efficacy of nitrofurantoin versus trimethoprim prophylaxis in preventing recurrent UTIs in children.
- To assess the impact of each prophylactic agent on bacterial resistance patterns and UTI recurrence in children with and without urinary tract abnormalities.
Main Methods:
- A randomized, double-blind study involving 130 children (aged 1-14 years) receiving 6 months of either nitrofurantoin or trimethoprim prophylaxis.
- Actuarial percentage recurrence-free curves were used to evaluate efficacy.
- Bacterial resistance patterns and causative agents of UTIs were monitored before, during, and after prophylaxis.
Main Results:
- Nitrofurantoin demonstrated superior efficacy in preventing recurrent UTIs in children with abnormal urography or reflux (p = 0.0025).
- Trimethoprim prophylaxis significantly increased resistance to trimethoprim (76% during prophylaxis) and altered bacterial flora, with higher rates of resistant E. coli and Staphylococcus epidermidis UTIs.
- No significant difference in recurrence-free rates was observed between the two groups in children without urinary tract abnormalities.
- Nitrofurantoin prophylaxis did not alter resistance patterns or bacteriology.
Conclusions:
- Nitrofurantoin is recommended as the first-line prophylactic treatment for children experiencing recurrent UTIs, particularly those with documented urinary tract abnormalities.
- Trimethoprim prophylaxis is associated with increased antibiotic resistance and should be used cautiously in this population.
- While side effects were more frequent with nitrofurantoin (gastrointestinal), its superior efficacy in specific subgroups justifies its use.
Abstract:
The efficiency of nitrofurantoin and trimethoprim prophylaxis in preventing recurrent urinary tract infections (UTI) was compared by means of actuarial percentage recurrence-free curves in a randomized, double blind study in 130 children (126 girls, 4 boys) aged 1 to 14 years (mean 7.5). The children received the antibiotics for 6 months. Nitrofurantoin proved to be the most efficient prophylactic drug in patients with abnormal urography and/or reflux (n = 60) as evaluated by actuarial percentage recurrence-free analysis (p = 0.0025). However, no differences was found in patients without urinary tract abnormalities. Nitrofurantoin prophylaxis altered neither the pattern of resistance nor the bacteriological constellation, while patients receiving trimethoprim prophylaxis had 76% trimethoprim resistant bacteria during prophylaxis, compared with 8% before (p less than 0.0001) and 17% after (p less than 0.0001) prophylaxis. The percentage of recurrences due to E. coli (70-80%) was unaffected by trimethoprim prophylaxis, but the proportion due to trimethoprim resistant E. coli was significantly higher during prophylaxis (65%) than before (6%, p less than 0.0001) and after (11%, p less than 0.001). The percentage of Staphylococcus epidermidis UTI was significantly higher during trimethoprim prophylaxis (27%) than before (2%, p less than 0.0003). Following prophylaxis there was no difference in the actuarial percentage recurrence-free curves of the two regimens. Side effects occurred more frequently in the nitrofurantoin group (37%) than in the trimethoprim group (21%) (p = 0.05). The majority of side effects in the nitrofurantoin group derived from gastrointestinal symptoms. In conclusion, nitrofurantoin is recommended as the first choice prophylactic treatment of children with recurrent UTI and urinary tract abnormalities.
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