Continuous Antibiotic Prophylaxis for Vesicoureteral Reflux: Impact on the Pediatric Microbiome-A Systematic Review

Area of Science:

• Pediatric Nephrology
• Microbiome Research
• Infectious Diseases

Background:

• Continuous antibiotic prophylaxis (CAP) is standard for infants with vesicoureteral reflux (VUR) to prevent urinary tract infections (UTIs) and renal scarring.
• Prolonged antibiotic exposure during infancy may impact the developing microbiome and immune system.
• The long-term consequences of CAP on the infant microbiome are not fully understood.

Purpose of the Study:

• To systematically review the effects of CAP on the gut and urinary microbiome in children with VUR.
• To assess changes in microbial composition, diversity, and antimicrobial resistance associated with CAP.
• To inform strategies for balancing infection prevention with microbiome health in infants.

Main Methods:

• Systematic review following PRISMA 2020 guidelines.
• Searched major databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library) up to September 2025.
• Included studies assessing microbiome changes in children (<18 years) receiving CAP for VUR using sequencing or culture methods.

Main Results:

• Four studies (3 observational, 1 RCT) met inclusion criteria.
• CAP maintained overall microbial alpha diversity but enriched Enterobacteriaceae and reduced Bifidobacteriaceae.
• The RCT showed reduced UTI recurrence but increased antimicrobial resistance and non-E. coli infections.

Conclusions:

• Infant CAP alters microbiota composition and resistance profiles despite preserving diversity.
• Findings suggest potential long-term ecological impacts of early-life antibiotic exposure.
• Individualized prophylaxis and microbiome-preserving interventions are needed to optimize VUR management.