Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group

Abstract

Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. Methods: A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results: The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended. Conclusions: Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk.

Value of contrast-enhanced sonography in the diagnosis of vesicoureteral reflux

“…Continuous antibiotic prophylaxis is recommended by current guidelines in the case of diagnosed vesicoureteral reflux. However, this is being reexamined in new studies from the year 2023 [4,41]. In the case of additional obstructive diseases of the urinary tract, antibiotic prophylaxis should be implemented [38].…”

Urinary Tract Infection in Children: A Narrative Review

“…Urine samples contribute to diagnosis; a catheter may be required for newborns [ 28 ]. Urinalysis and culture confirm pathogens [ 29 ]. Prompt detection is crucial to prevent kidney infections.…”

“…Prompt detection is crucial to prevent kidney infections. Tailored antibiotics are essential, and completing the course is necessary to prevent recurrence and antibiotic resistance [ 29 ]. Preventive measures involve promoting hygiene, ensuring complete bladder emptying, treating constipation, and addressing urinary abnormalities [ 10 ].…”

Pathogens Causing Pediatric Community Acquired Urinary Tract Infections and Their Increasing Antimicrobial Resistance: A Nationwide Study

“…The prevalence of UTIs varies according to age, gender, and geographical location. Up to 8% of children experience at least one UTI between the ages of 1 month and 11 years, and up to 30% of infants and children experience recurrent infections during the first 6 to 12 months after an initial UTI [ 4 , 5 ]. Pediatric UTIs are associated with significant acute morbidity and may cause long-term complications such as arterial hypertension, renal scarring, and even chronic renal failure [ 1 , 6 ].…”