Antibiotics for performing voiding cystourethrogram: a randomised control trial

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Radiology

Background:

• Urinary tract infections (UTIs) are common in children.
• Voiding cystourethrogram (VCUG) is a key diagnostic imaging technique for evaluating UTIs and urinary tract abnormalities.
• There is a risk of developing a UTI associated with the VCUG procedure itself.

Purpose of the Study:

• To determine if antibiotic prophylaxis can decrease the rate of UTIs acquired after a VCUG procedure.
• To identify specific patient groups who may benefit most from antibiotic prophylaxis before VCUG.

Main Methods:

• An open-label randomized controlled trial was conducted involving 120 children aged 2 months to 5 years undergoing VCUG.
• Participants were randomized to receive oral antibiotics (cephalexin or co-trimoxazole) or no antibiotics.
• UTI incidence was assessed three days post-VCUG, defined by symptomatic infection and significant bacterial growth.

Main Results:

• The incidence of post-VCUG UTI was significantly lower in the antibiotic group (1.4%) compared to the no-antibiotic group (17%) (p=0.01).
• An abnormal pre-VCUG ultrasound scan was identified as an independent risk factor for post-VCUG UTI (OR=9.51).
• The number needed to treat with antibiotics to prevent one UTI was 6.5, reducing to 4 for children with abnormal ultrasound scans.

Conclusions:

• Antibiotic prophylaxis is effective in reducing the occurrence of UTIs after VCUG in children.
• The benefit of antibiotic prophylaxis is most pronounced in children with abnormal pre-VCUG ultrasound findings.
• This strategy can help minimize infectious complications associated with diagnostic imaging in pediatric urology.