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Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis

Luis H Braga1, Hana Mijovic, Forough Farrokhyar

  • 1Department of Surgery, McMaster University, Hamilton, Ontario, Canada. braga@mcmaster.ca

Pediatrics
|December 19, 2012
PubMed

Insights

Continuous antibiotic prophylaxis (CAP) may benefit newborns with high-grade antenatal hydronephrosis (HN) by significantly reducing urinary tract infection (UTI) rates. However, evidence quality is moderate to low, and other factors were not assessed.

Area of Science:

  • Pediatric Nephrology
  • Infectious Disease Prevention
  • Neonatal Urology

Background:

  • Continuous antibiotic prophylaxis (CAP) is a common recommendation for preventing urinary tract infections (UTIs) in newborns diagnosed with antenatal hydronephrosis (HN).
  • High-level evidence supporting the routine use of CAP in this population is limited.
  • This systematic evaluation aims to clarify the efficacy of CAP in reducing UTI rates among infants with HN.

Purpose of the Study:

  • To systematically evaluate the effectiveness of continuous antibiotic prophylaxis (CAP) in preventing urinary tract infections (UTIs) in infants with antenatal hydronephrosis (HN).
  • To determine the clinical value of CAP in this specific pediatric population.

Main Methods:

  • A systematic review of pertinent articles and gray literature published between 1990 and 2010 was conducted.
  • Studies included infants under 2 years old with antenatal HN, comparing outcomes with and without CAP.
  • Data on UTI development, voiding cystourethrogram (VCUG) results, and HN grade were extracted and analyzed.

Main Results:

  • The analysis included 21 studies with 3876 infants; 76% were of moderate or low quality.
  • For low-grade HN, UTI rates were similar with or without CAP (2.2% vs 2.8%).
  • For high-grade HN, CAP significantly reduced UTI rates (14.6% vs 28.9%), with an estimated number needed to treat of 7.

Conclusions:

  • Continuous antibiotic prophylaxis (CAP) shows potential benefit for infants with high-grade HN in preventing UTIs.
  • The impact of confounding variables like gender, reflux, and circumcision status could not be determined.
  • The overall quality of evidence supporting CAP for antenatal hydronephrosis is moderate to low.
Abstract

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