Antibiotic prophylaxis in the management of vesicoureteric reflux: a randomized double-blind placebo-controlled trial

Abstract

Long-term antibiotic prophylaxis with TMP-SMX is associated with increased risk of symptomatic UTI compared to placebo in children with grade I-IV VUR.

Uropathogen Resistance and Antibiotic Prophylaxis: A Meta-analysis

“…Of first recurrent UTIs, 86% were Escherichia coli, which was not statistically significant between control (86%) and prophylaxis (85%) groups (P = .74). Of first recurrent UTIs by study, none of those in Brandström et al 21 had multidrug resistance, whereas 62% of those in Hari et al 22 had multidrug resistance. The remaining studies had 9% to 25% with multidrug resistance ( Table 2).…”

“…19,24 Two studies included bagged urine samples, 19,21 and authors of 1 study failed to describe how urine was collected in nontoilet-trained children (Supplemental Fig 3). 22 Funnel plots did not reveal visual evidence of publication bias (Supplemental Fig 4).…”

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

“…22 Interestingly, similar to Garin et al, they also showed that CAP might actually be harmful, as there was an increased risk of symptomatic UTIs (21%) in the prophylaxis group compared to placebo (7%; HR 3.9; p=0.02). Renal scans at 12 months showed similar rates of development of new or worsening of pre-existing renal scars for both groups (CAP 16% vs. placebo 16%).…”

“…18,22,26 An analysis of data on 186 patients with recurrent UTI enrolled in four RCTs comparing CAP and UTI prevention was reported by Selekman et al 26 The most common uropathogen was Escherichia coli (E. coli) (86%) and its prevalence did not differ in CAP (87%) compared to no CAP (85%) patients (p=0.82). The authors showed that the most common drug used for prophylaxis was co-trimoxazole (85%) and 31% of first recurrent UTIs had coresistance, while 16% had multidrug resistance.…”

“…[19][20][21][22] Pennesi et al performed a RCT of 100 patients (52 female and 48 male, age one day to 30 months) with VUR (Grade II-IV) after a first episode of acute pyelonephritis. 19 After two years of followup, the authors found no statistically significant difference in terms of recurrent pyelonephritis between the CAP (36%) and control (30%) groups, as well as no difference in the rate of subsequent UTIs and renal scarring.…”