INTRODUCTION AND OBJECTIVES: Continuous antibiotic prophylaxis (CAP) has been recommended for children with VUR until toilet training to prevent urinary tract infections (UTI). We have had the chance to investigate this concept at our institution by prospectively following 2 cohorts, managed by 2 surgeons with differing practices regarding the age of CAP discontinuation (CAP-DC). Our objective was to compare fUTI rates between these 2 cohorts. We hypothesized that UTI rates would be similar for both cohorts, with the early CAP-DC group having a more favorable antibiotic resistance profile. METHODS: We prospectively followed 2 cohorts of patients with primary VUR ( 0e18years) from 2009e18 (n[275): CAP-DC occurred at 12e18 months of age in Cohort-I and at toilet training age (24e36 months) in Cohort-II. Age at and mode of presentation, gender, VUR and hydronephrosis (HN) grades, ureteral dilation, UTI and surgery rates, and follow-up time were collected. Our primary outcome was development of fUTI post-CAP-DC in both groups. We performed subgroup analyses to determine risk factors for UTI post-CAP-DC in both cohorts. Statistical analyses consisted of chi-square for categorical data and t-tests for continuous variables. RESULTS: Of 275 patients, 174-63% (Cohort-I) stopped CAP at a mean age of 16mos (IQR 11) and 101-37% (Cohort-II) at 27mos (IQR 25). Patient characteristics are displayed in Table-1. The median age at presentation were 10.4 (IQR: 7) and 7 (IQR: 16) months for Cohort-I and Cohort-II, respectively. Follow-up was 40þ26months for Cohort-I vs. 54þ34months for Cohort-II (p<0.01). There were more patients with dilating VUR (3-5) (152/174;87%) in Cohort-I vs. Cohort-II (80/101;79%) (p[0.05). A total of 32 patients developed UTI post-CAP-DC [19/174 (11%) vs. 13/101 (13%); p[0.63] and the mean time to the development of UTI post-CAP-DC was 7þ8months for Cohort-I vs. 14þ20months for Cohort-II (p[0.19) (Table 2). Both groups had similar rates of VUR correcting surgery (25%vs.24% for Cohort-I and II, respectively).CONCLUSIONS: Stopping CAP in VUR children at a median age of 16mos did not result in more UTIs when compared to the traditional approach. By adopting such strategy, duration of antibiotic exposure may be decreased without adversely increasing UTI rates. Discontinuation of CAP early may be more beneficial for males as 75% of patients who had UTIs post-CAP-DC were females, had more often BBD and dilating VUR.
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