Antibiotic Prophylaxis for Prevention of Febrile Urinary Tract Infections in Children with Vesicoureteral Reflux: A Meta-Analysis of Randomized, Controlled Trials Comparing Dilated to Nondilated Vesicoureteral Reflux

Bessa, José de; Mrad, Flávia Cristina de Carvalho; Mendes, Evilin Feitosa; Bessa, Marcia Carvalho; Paschoalin, Victor; Tiraboschi, Ricardo Brianezi; Sammour, Zein M.; Gomes, Cristiano Mendes; Braga, Luis H.; Netto, José Murillo Bastos

doi:10.1016/j.juro.2014.10.092

Cited by 39 publications

(21 citation statements)

References 20 publications

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“…Prophylaxis may be discontinued if VUR is not observed in the control imaging after the first year. If breakthrough infections occur under this antibiotic prophylaxis, surgical treatment should be attempted [16].…”

Section: Discussionmentioning

confidence: 99%

Critical analysis of the outcome of primary unilateral vesicoureteral reflux in a medium volume center

et al. 2020

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Background Vesicoureteral reflux (VUR) is a common finding in pediatric age group. Here in we explored the possible risk factors that affect the rate of resolution in patients with primary unilateral VUR under conservative treatment. Methods Between 2006 and 2014, we retrospectively evaluated all VUR patients and included only patients with primary unilateral VUR. Records were reviewed for patient age at diagnosis, antenatal history, patient gender, mode of presentation, side, and grade of VUR, associated hydronephrosis (HN) on renal ultrasound, presence of scarring and split function on dimercaptosuccinic acid (DMSA) scan. Clinical and radiological outcomes were assessed. Both univariate and multivariate analysis were conducted. Results A total of 68 patients with primary unilateral VUR were included (32 boys and 36 girls) with a mean age of 10 months (range 1–32). Antenatal HN was detected in 50% of patients. In 15 cases (22%), VUR was of high grade (IV–V). Associated HN was evident in 39 patients (57%). DMSA scans showed renal scarring in 16 patients (23%). After a mean follow-up of 7 years, VUR resolved in 49 patients (72%). Significant predictors for VUR resolution were VUR grade, DMSA split function and associated high-grade HN. High-grade HN with VUR was the only significant independent risk factor. Conclusions The rate of resolution in primary unilateral VUR under conservative treatment is significantly affected by VUR grade, DMSA split renal function and the presence of associated HN. Association of high-grade HN with VUR carries a low chance for spontaneous resolution.

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Section: Discussionmentioning

confidence: 99%

Critical analysis of the outcome of primary unilateral vesicoureteral reflux in a medium volume center

et al. 2020

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“…Two meta-analyses studying the efficacy of CAP have been published since the RIVUR trial [2627]. The first meta-analysis by Wang et al [26] included 8 randomized, controlled trials [1516171819202128].…”

Section: Meta-analysis Post Rivurmentioning

confidence: 99%

“…There was no decrease in new renal scarring or difference in reported adverse events. de Bessa et al [27] analyzed 7 randomized, controlled trials comparing CAP and no prophylaxis/placebo in children with reflux [151617192021]. Analysis prior to RIVUR trial revealed benefit only to children with high-grade reflux, but addition of data from RIVUR study revealed pooled data that supports CAP in all children with reflux.…”

Section: Meta-analysis Post Rivurmentioning

confidence: 99%

Vesicoureteral reflux and continuous prophylactic antibiotics

Lee

Park

2017

Investig Clin Urol

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Vesicoureteral reflux (VUR) management must be tailored based on the risk for further infections and renal scarring, gender, likelihood of spontaneous resolution, and parental preferences. Because we now understand that sterile VUR is benign and most reflux spontaneously resolves over time, the initial approach in majority of children is non-surgical with continuous antibiotic prophylaxis (CAP) and correction of bladder and bowel dysfunction. Despite increasing utilization of CAP over the past four decades, the efficacy of antibiotic prophylaxis has been questioned due to conflicting results of studies plagued with design flaws and inadequate subject sample size. The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial, which was designed to address many of the limitations from previous studies, provided much needed answers. In this review, we sought to describe the controversy surrounding VUR management, highlight the results of RIVUR trial, and discuss how the RIVUR findings impact our understanding of CAP in the management of VUR.

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“…24 After initial analysis of the trials, CAP was determined to be beneficial only in children with high-grade VUR (Grade III/IV). However, with the addition of the data from the 2014 RIVUR study, the new pooled data support CAP in all children with VUR to prevent recurrent UTI, regardless of reflux grade.…”

Section: Systematic Reviewsmentioning

confidence: 99%

Continuous antibiotic prophylaxis in the setting of prenatal hydronephrosis and vesicoureteral reflux

Wong

Koyle

Braga

2017

CUAJ

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Continuous antibiotic prophylaxis (CAP) has traditionally been offered for children with recurrent urinary tract infections (UTIs) or those at risk, including children diagnosed with prenatal hydronephrosis (HN) and vesicoureteral reflux (VUR). However, indications for antibiotic prophylaxis are controversial, data on who should benefit from this therapy is conflicting and, thus, guidelines are unable to provide conclusive recommendations. In the setting of prenatal HN, although randomized trials are currently underway, most evidence is derived from low-to moderate-quality observational studies. Although there is no benefit in those with low-grade HN, a systematic review of the available studies showed that highgrade HN patients on prophylaxis experienced fewer infections with an estimated number needed to treat of 7. On the other hand, there are eight randomized trials that have investigated the use of antibiotic prophylaxis in the setting of VUR. Although four of the studies have demonstrated some value of prophylaxis and the other four have not, meta-analysis has shown an overall benefit of antibiotic prophylaxis in preventing infections. The observed differences are likely due to different inclusion criteria and study heterogeneity. Although generalizing results of meta-analyses to all children is tempting, an individualized approach, by determining which patients best behave like those of the included studies, is recommended.

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Antibiotic Prophylaxis for Prevention of Febrile Urinary Tract Infections in Children with Vesicoureteral Reflux: A Meta-Analysis of Randomized, Controlled Trials Comparing Dilated to Nondilated Vesicoureteral Reflux

Abstract: Vesicoureteral reflux management is still controversial. In contrast to recently published studies and guidelines, this meta-analysis supports antibiotic prophylaxis in all children with vesicoureteral reflux regardless of reflux grade. More studies are needed to support this finding.

Cited by 39 publications

References 20 publications

Critical analysis of the outcome of primary unilateral vesicoureteral reflux in a medium volume center

Critical analysis of the outcome of primary unilateral vesicoureteral reflux in a medium volume center

Vesicoureteral reflux and continuous prophylactic antibiotics

Continuous antibiotic prophylaxis in the setting of prenatal hydronephrosis and vesicoureteral reflux

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