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Intermittent trimethoprim-sulfamethoxazole in children with vesicoureteral reflux
C Hori1, M Hiraoka, H Tsukahara
1Department of Pediatrics, Fukui Medical School, Japan.
Insights
Intermittent low-dose trimethoprim-sulfamethoxazole (TMP-SMZ) effectively prevents recurrent urinary infections in children with vesicoureteral reflux. This antibiotic prophylaxis showed high efficacy, with minimal side effects observed in the study group.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Recurrent urinary tract infections (UTIs) are a common concern in children, particularly those with vesicoureteral reflux (VUR).
- Established efficacy of trimethoprim-sulfamethoxazole (TMP-SMZ) in adult UTI prophylaxis.
- Need to assess TMP-SMZ in pediatric VUR population.
Purpose of the Study:
- To evaluate the effectiveness of intermittent low-dose TMP-SMZ for preventing recurrent UTIs in children with VUR.
- To assess the safety profile of this prophylactic regimen in the pediatric population.
Main Methods:
- A cohort of 35 children (aged 1 month to 9 years) with VUR received TMP-SMZ (1 mg/kg TMP, 5 mg/kg SMZ) every other day at bedtime.
- Prophylaxis duration ranged from 6 to 50 months.
- Urinary infection recurrence rates and adverse events were monitored.
Main Results:
- No UTIs recurred in the 24 boys during the study period.
- Two girls experienced a total of 7 UTIs, with a recurrence rate of 0.027 per patient month.
- Two infants developed transient neutropenia, which resolved spontaneously.
Conclusions:
- Intermittent low-dose TMP-SMZ is highly effective in preventing recurrent UTIs in children with VUR, including higher grades.
- The treatment is generally safe, with transient neutropenia being the main observed side effect.
- TMP-SMZ offers a viable prophylactic option for pediatric VUR patients at risk for recurrent infections.
Abstract:
The effectiveness of intermittent low-dose trimethoprim-sulfamethoxazole (TMP-SMZ) for the prophylaxis of recurrent urinary infection is well established in adults. The present study assessed the effectiveness and safety of intermittent low-dose TMP-SMZ in 35 children (24 boys, 11 girls, aged 1 month to 9 years, median age 5 months) with vesicoureteral reflux; 18 children had bilateral reflux. A total of 53 refluxing ureters were graded as I in 2, II in 16, III in 19, IV in 14, and V in 2 cases. The children were given 1 mg/kg body weight of trimethoprim together with 5 mg/kg of sulfamethoxazole at bedtime every other day for 6-50 months (mean +/- SD, 22.9 +/- 11.7 months). None of the boys had a recurrence of urinary infection, while 2 of the 11 girls had a total of 7 recurrences during the prophylaxis period, with a recurrence rate of 0.027 per patient month in girls. Both girls were over 3 years and had a mildly unstable bladder. Transient neutropenia (< 1,000/microliter) developed in 2 infants during the prophylaxis period, but disappeared spontaneously. Intermittent low-dose TMP-SMZ seemed very effective for the prevention of recurrent urinary infection in children with ureteral reflux even of higher grades.