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Updated: Jul 16, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Antimicrobial prophylaxis for vesicoureteral reflux: which subgroups of children benefit the most?
Beibo Zhao1, Anastasia Ivanova1, Nader Shaikh2
1The University of North Carolina at Chapel Hill Gillings School of Global Public Health.
Insights
Long-term antibiotic prophylaxis benefits select children with vesicoureteral reflux (VUR). Subgroup analysis of the RIVUR trial identified children with bowel-bladder dysfunction (BBD) or high-grade VUR as having a lower number needed to treat for UTI prevention.
Area of Science:
- Pediatric Nephrology
- Urology
- Infectious Diseases
Background:
- The Randomized Intervention for children with Vesicoureteral Reflux (RIVUR) trial showed antimicrobial prophylaxis reduced UTI recurrences by 50%.
- However, the overall number needed to treat (NNT) was 10, indicating a need to identify specific patient subgroups who benefit more.
- Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder to the kidneys, increasing UTI risk.
Approach:
- Patient-level data from the RIVUR trial was re-analyzed using penalized regression methods.
- Covariates included baseline age, VUR grade, and bowel-bladder dysfunction (BBD).
- The analysis focused on identifying subgroups with a favorable trade-off between absolute risk difference and subgroup size.
Key Points:
- Three subgroups with significantly lower NNTs for UTI prevention were identified.
- Children with grade IV VUR and BBD had an NNT of 2.
- Children with BBD (NNT=4) or a combination of BBD/any VUR or grade IV VUR/any BBD (NNT=4) also showed benefit.
Conclusions:
- Long-term antimicrobial prophylaxis is particularly beneficial for children with VUR and BBD, or high-grade VUR.
- These specific subgroups experience a more favorable number needed to treat for preventing recurrent UTIs.
- Targeted prophylaxis strategies can optimize treatment efficacy in pediatric VUR management.
Background:
While the Randomized Intervention for children with Vesicoureteral Reflux (RIVUR) trial found that long-term antimicrobial prophylaxis reduced the risk of urinary tract infection (UTI) recurrences by 50%, 10 children had to be treated with long-term antimicrobial prophylaxis for one to benefit (i.e., observed number needed to treat (NNT) of 10). Accordingly, we re-analyzed RIVUR data to systematically identify subgroups of children with vesicoureteral reflux (VUR) with a smaller NNT.
Methods:
Using patient-level data from the RIVUR trial, we applied penalized regression methods including the baseline age, VUR, and bowel-bladder dysfunction (BBD) as covariates to identify subgroups that consider the trade-off between absolute risk difference and size.
Results:
We identified three relevant subgroups of children that appear to benefit from long-term antimicrobial prophylaxis, all with NNTs smaller than the NNT of 10. Children with grade IV VUR and BBD, 1% of the RIVUR sample, had a NNT of 2; children with BBD, 12% of the RIVUR sample, had a NNT of 4; children with BBD (and any grade VUR) or with grade IV VUR (regardless of BBD status), which was the combination of the first two subgroups and included 19% of children in the RIVUR sample, had a NNT of 4.
Conclusions:
Use of long-term antimicrobial prophylaxis appears to be particularly relevant for children with BBD (and any grade of VUR) or those with grade IV VUR (regardless of BBD status) who were at high risk of UTI recurrences.
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