Antibiotic Prophylaxis for Vesicoureteral Reflux Revisited
2008; American Academy of Pediatrics; Volume: 19; Issue: 5 Linguagem: Inglês
10.1542/gr.19-5-49
ISSN1556-326X
Autores Tópico(s)Urinary Tract Infections Management
ResumoUrology| May 01 2008 Antibiotic Prophylaxis for Vesicoureteral Reflux Revisited AAP Grand Rounds (2008) 19 (5): 49–50. https://doi.org/10.1542/gr.19-5-49 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Antibiotic Prophylaxis for Vesicoureteral Reflux Revisited. AAP Grand Rounds May 2008; 19 (5): 49–50. https://doi.org/10.1542/gr.19-5-49 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: antibiotic prophylaxis, urinary tract infections, vesico-ureteral reflux, trimethoprim-sulfamethoxazole combination Source: Roussey-Kesler G, Gadjos V, Idres N, et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol. 2008;179(2):674–679; doi:10.1016/j.juro.2007.09.090 The management of low-grade vesicoureteral reflux (VUR) remains controversial. To determine if daily antimicrobial prophylaxis reduces the incidence of urinary tract infection (UTI) in young children with low-grade VUR, investigators from 17 pediatric centers in France studied 225 children between 1 and 36 months of age diagnosed with grade I–III VUR after febrile urinary infection. One hundred and three children were randomized to daily prophylaxis with cotrimoxazole (10 mg/kg sulfamethoxazole and 2 mg/kg trimethoprim) and 122 received no treatment. Exclusion criteria included initial infection with a urinary pathogen resistant to cotrimoxazole, abnormal renal ultrasound, obstructive uropathy, and allergy to sulfonamides. Dipstick urinalysis was performed in all children monthly and in any child with signs or symptoms of UTI. Urine was collected in sterile bags for non-toilet trained children, and from clean voided mid-stream for toilet-trained children. Cultures were sent if the leukocyte and/or nitrite test were positive. The study end points were either 18 months from enrollment or the occurrence of a UTI (>105 bacteria/mL of a single organism). Of 225 children enrolled, 69 were boys and 199 completed the study. There were no statistical differences between the two groups for age, gender ratio, or VUR grade distribution. Boys were younger at the time of enrollment (7 vs 13 months) and had more bilateral reflux (56% vs 40%) than girls. Most boys were uncircumcised. Only 50 children (22%) developed a second UTI; most cases (78%) occurred in girls. There was no difference in the recurrence of UTI (17% in prophylaxis vs 26% in the control group), febrile UTI (19% vs 16%), or the probability of infection-free survival between the groups. Twenty-seven percent of patients in the prophylaxis group had a UTI with an organism sensitive to cotrimoxazole versus 61% in the control group. No significant differences were observed between the two groups in terms of UTI recurrence for grade I, II, or III reflux. Prophylaxis significantly reduced UTI only in boys with grade III VUR. No child with grade I VUR had a second febrile UTI. Young age at inclusion did not increase the risk of UTI. The authors conclude that daily low-dose prophylactic antibiotics might benefit boys with grade III VUR but otherwise does not reduce the risk of UTI in young children with grades I–III VUR. Dr. Palmer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Data from the 1960s indicate that infections correlate with renal scarring and subsequent hypertension, or in severe cases, renal damage and even renal insufficiency.1 The goal of identifying children with VUR has traditionally been to prevent a first UTI in children identified by screening VCUG because of prenatally detected hydronephrosis or because of... You do not currently have access to this content.
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