[E. coli acute pyelonephritis: prophylaxis]

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Urology

Context:

• Recurrent urinary tract infections (UTIs) in children pose a risk for long-term renal complications.
• Establishing effective prevention strategies is crucial to mitigate sequelae like hypertension and end-stage renal failure.

Purpose:

• To evaluate the effectiveness of current strategies for preventing recurrent UTIs in children.
• To analyze the evidence regarding antibioprophylaxis, alternative measures, and surgical interventions.

Summary:

• A recent meta-analysis found no benefit of antibiotic prophylaxis for febrile UTIs in infants, irrespective of vesicoureteral reflux.
• Concerns exist regarding adverse events and the promotion of antibiotic resistance (e.g., extended-spectrum beta-lactamases) with long-term antibiotic use.
• Alternative preventive measures like cranberries, pre/probiotics are inconclusive; surgery is indicated for specific uropathies; dysfunctional elimination syndrome requires treatment.

Impact:

• Current evidence challenges the routine use of antibioprophylaxis in pediatric recurrent UTIs.
• Highlights the need for individualized treatment decisions in consultation with specialists.
• Emphasizes the importance of addressing dysfunctional elimination syndrome as a key factor in management.