Antimicrobial prophylaxis for urinary tract infections: implications for adherence assessment

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Clinical Pharmacology

Background:

• Continuous antimicrobial prophylaxis is used to reduce recurrent urinary tract infections (UTIs) in children with vesicoureteral reflux (VUR).
• However, poor adherence to daily prophylactic medication is a significant challenge.

Purpose of the Study:

• To identify patient and caregiver factors associated with non-adherence to antimicrobial prophylaxis.
• To determine if adherence levels influence the effectiveness of prophylaxis in preventing recurrent UTIs and renal scarring in children with VUR.

Main Methods:

• Secondary analysis of the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial data.
• Ordinal logistic regression was used to assess predictors of non-adherence.
• Efficacy of prophylaxis was examined across adherence quartiles.

Main Results:

• Non-adherence was not associated with demographic factors or disease severity.
• In toilet-trained children, higher bladder and bowel dysfunction (BBD) scores correlated with non-adherence.
• Lowest adherence (<70%) was linked to a 2.5-fold increased risk of recurrent UTI and a 24.2-fold increased risk of renal scarring compared to highest adherence (>96%).

Conclusions:

• Adherence to antimicrobial prophylaxis is critically linked to clinical outcomes in pediatric VUR.
• Non-adherence is a distinct clinical issue associated with increased risk of renal scarring.
• Assessment of adherence should be integrated into VUR prophylaxis management algorithms.