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A short-term study of nitrofurantoin prophylaxis in children managed with clean intermittent catheterization

H W Johnson1, J D Anderson, G K Chambers

  • 1Department of Surgery, University of British Columbia, Vancouver, Canada.

Pediatrics
|May 1, 1994
PubMed

Insights

Daily nitrofurantoin macrocrystals significantly reduced urinary tract infections in children with neurogenic bladder. This antibiotic prophylaxis shows promise for managing this condition.

Area of Science:

  • Pediatric Urology
  • Infectious Diseases
  • Nephrology

Background:

  • Neurogenic bladder, often associated with meningomyelocele, presents a significant challenge in pediatric care.
  • Evidence for the efficacy of antibiotic prophylaxis in children with neurogenic bladder is lacking.
  • Urinary tract infections (UTIs) are a common complication in this population, potentially leading to renal damage.

Purpose of the Study:

  • To evaluate the effectiveness of once-daily nitrofurantoin macrocrystals as antibiotic prophylaxis in children with neurogenic bladder.
  • To assess the impact of nitrofurantoin on the incidence of urinary tract infections in a selected pediatric population.

Main Methods:

  • A 24-week, double-blinded, placebo-controlled crossover study was conducted.
  • Fifty-six children with neurogenic bladder due to meningomyelocele participated.
  • Children with other significant urinary tract abnormalities were excluded. UTIs were defined by bacterial counts and pyuria or symptoms. Infection status was monitored bi-weekly.

Main Results:

  • A significant reduction in the average percentage of UTIs per patient was observed, decreasing from 39% on placebo to 19% on nitrofurantoin prophylaxis (P < .0003).
  • During the initial 12 weeks, UTI rates dropped from 45% on placebo to 22% on prophylaxis (P < .0018).
  • A notable protective carryover effect of nitrofurantoin was observed even when patients switched to the placebo arm.

Conclusions:

  • Nitrofurantoin macrocrystals demonstrated effectiveness as a prophylactic agent for urinary tract infections over a 3-month period in children with neurogenic bladder.
  • Further long-term studies are warranted to confirm the potential benefits of nitrofurantoin in preventing urinary tract damage.
  • The findings support the use of nitrofurantoin for short-term prophylaxis in this specific pediatric population.
Abstract

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