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Prophylaxis Options in Children With a History of Recurrent Urinary Tract Infections: A Systematic Review
Nikolaos Gkiourtzis1, Anastasia Stoimeni1, Agni Glava1
14th Department of Pediatrics, "G.Papageorgiou" General Hospital School of Medicine, Department of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Insights
Nitrofurantoin and cranberry products may reduce symptomatic urinary tract infection (UTI) episodes in children with recurrent UTI (RUTI). However, no current prophylaxis effectively prevents kidney scarring in these patients.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Recurrent urinary tract infections (RUTI) in children pose a significant clinical challenge.
- Antibiotic prophylaxis is often used to prevent further UTI episodes and complications in pediatric RUTI cases.
Conclusions:
- Nitrofurantoin and cranberry products show promise in decreasing symptomatic UTI episodes in pediatric patients with RUTI.
- Further RCTs are needed to evaluate non-antibiotic prophylaxis for UTI recurrence and kidney scarring risk in children.
- Current evidence does not support any prophylaxis method for preventing kidney scarring in pediatric RUTI.
Context:
The prevention of urinary tract infection recurrence (UTI) in children has been a challenge yet to be solved. Current practice in children with recurrent UTI (RUTI) suggests that antibiotic prophylaxis may prevent further episodes of UTI and future complications.
Objective:
To conduct a systematic review and meta-analysis of randomized controlled trials comparing prophylaxis options for the prevention of UTI and kidney scarring in children with a history of RUTI.
Data Sources:
We conducted a systematic literature search through major electronic databases (PubMed/Medline, Scopus and Cochrane Library) up to November 26th, 2023. Mean difference and SD were used for continuous outcomes and odds ratio for dichotomous outcomes.
Study Selection:
Our meta-analysis included 3335 participants from 23 studies.
Data Extraction:
The primary outcome was the effect of the different prophylaxis options on the incidence of symptomatic UTI in children with RUTI during prophylactic treatment.
Results:
Cranberry products and nitrofurantoin lead to lower odds of symptomatic UTI episodes during prophylaxis compared with the control group and control, trimethoprim-sulfamethoxazole, or trimethoprim groups accordingly. Nitrofurantoin may be the best option for UTI incidence reduction compared with all available documented interventions.
Limitations:
No prophylaxis option has been shown to reduce kidney scarring.
Conclusions:
Nitrofurantoin and cranberry products may decrease the incidence of symptomatic UTI episodes in pediatric patients with a history of RUTI. Future randomized control trials studying nonantibiotic prophylaxis options focusing on children with UTI recurrence and the risk for kidney scarring are needed to draw further conclusions.
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