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Antimicrobial prophylaxis in children with urinary tract infection and vesicoureteral reflux
Insights
This study on children with urinary tract infections and vesicoureteral reflux found that antimicrobial prophylaxis effectively prevented recurrent infections. Long-term evaluation is needed to confirm if prophylaxis or surgery prevents kidney damage.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTIs) and vesicoureteral reflux (VUR) are common in children.
- Recurrent UTIs can lead to kidney scarring (reflux nephropathy) and chronic pyelonephritis.
Purpose of the Study:
- To evaluate the efficacy of antimicrobial prophylaxis in preventing recurrent UTIs in children with nonobstructive VUR.
- To compare outcomes between antimicrobial prophylaxis alone and prophylaxis plus corrective surgery.
Main Methods:
- Prospective follow-up of 30 children with UTI and nonobstructive VUR.
- Randomized assignment to antimicrobial prophylaxis (trimethoprim-sulfamethoxazole or nitrofurantoin) alone or with surgery.
- Regular monitoring of urine cultures, blood counts, and liver function tests.
Main Results:
- Antimicrobial prophylaxis with trimethoprim-sulfamethoxazole or nitrofurantoin was effective in preventing recurrent UTIs.
- No significant hematologic or hepatic abnormalities were observed with either drug.
- Preliminary findings suggest prophylaxis or surgery may prevent chronic pyelonephritis/reflux nephropathy.
Conclusions:
- Antimicrobial prophylaxis is a safe and effective strategy for managing UTIs in children with VUR.
- Further long-term studies are necessary to definitively establish the benefits of prophylaxis versus surgery in preventing renal damage.
Abstract:
Thirty children with urinary tract infection and nonobstructive vesicoureteral reflux have been followed prospectively for a mean of 17 months. After classification according to age and grade of reflux, 10 patients were assigned at random to treatment with antimicrobial prophylaxis alone or antimicrobial prophylaxis plus corrective surgery. Twenty other patients were also treated with antimicrobial prophylaxis alone. All were assigned at random to treatment with a single daily dose of trimethoprim-sulfamethoxazole or nitrofurantoin. Cultures of urine, complete blood cell counts, and determination of levels of aspartate aminotransferase in serum were performed regularly during follow-up. Both drugs proved effective in prevention of recurrent infection, and no significant hematologic or hepatic abnormalities were noted. Current results suggest that either prophylaxis or surgery may effectively prevent chronic pyelonephritis or reflux nephropathy, but only continuing evaluation of this group of patients will confirm these results.