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

Wong, Nathan; Koyle, Martin A.; Braga, Luis H.

doi:10.5489/cuaj.4387

Cited by 7 publications

(3 citation statements)

References 26 publications

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“…Since VUR predisposes to UTIs, daily prophylactic antibiotics are prescribed for higher grades of VUR. Although recent studies have found conflicting evidence to support this practice, most guidelines still recommend it [15,19]. The definite treatment for VUR is strictly surgical.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2021

Clin Med Rev Case Rep

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Vesicoureteral reflux (VUR) is the most common urologic pathology in the pediatric population. VUR is defined as primary when the intravesical portion of the ureters is short and produces an incompetent ureterovesical junction. Secondary VUR is caused by anatomical or functional obstruction to bladder emptying, which in turn increases the bladder internal pressure, therefore overcoming the ureterovesical junction and causing reflux. Current guidelines reflect on whether patients of a certain age with a febrile urinary tract infection should be offered imaging studies to detect urinary tract anatomical abnormalities, but there are conflicting recommendations for other age groups. VUR should be a high suspicion on patients with recurrent urinary tract infections, and it should be detected early to prevent further renal damage that can lead to end-stage renal disease. 10 3 /µL, Hb 13.3 g/dL, Hematocrit 42.8%, MCV 77.1 fL, Platelets 376 10 3 /µL, Glucose 87 mg/dL, Urea 42.9 mg/ dL, BUN 20 mg/dL, Creatinine 0.56 mg/dL.Urinalysis demonstrated Specific Gravity 1.018, pH 8.00, Leukocyte esterase 500/µL, Positive nitrites, Protein 25 mg/dL, negative for glucose and ketones. Microscopic exam revealed Leukocytes 8/field, no eryth-

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Section: Discussionmentioning

confidence: 99%

Untitled

2021

Clin Med Rev Case Rep

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“…UTIs in the pediatric population are associated with long-term complications, including hypertension, renal insufficiency, renal scarring, and growth impairment [16]. Newborns with AHN have been shown to have a twelve-fold higher risk of hospitalization, predominately in the first year of life, and VUR accounts for approximately 10%-15% of children with prenatal HN [17]. Both hydroureteronephrosis and VUR are considered risk factors for febrile UTIs [14].…”

Section: Review Discussionmentioning

confidence: 99%

Role of Antibiotic Prophylaxis in the Management of Antenatal Hydronephrosis, Vesicoureteral Reflux, and Ureterocele in Infants

Zaveri

Perry

Schuetz

et al. 2020

Cureus

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Widespread prenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. Antenatal hydronephrosis (AHN) and vesicoureteral reflux (VUR) are among the most common congenital anomalies diagnosed in utero or after birth. Pediatric urologists frequently rely on continuous antibiotic prophylaxis (CAP) for managing AHN, VUR, and ureterocele, unless definitive treatment is performed. The main aim of antibiotic prophylaxis (ABP) is to prevent urinary tract infection and long-term complications. Nevertheless, the efficacy of ABP has been a source of considerable debate, and pediatricians have varied opinions on who would benefit from ABP. In this review article, we searched the currently available literature, for evidence of the role of ABP in the setting of AHN, VUR, and ureterocele. Most of our studies showed a limited benefit of ABP for HN and VUR. The data on the use of CAP in the management of ureterocele is scarce. However, due to the involvement of independent risk factors and other variables, a conclusion cannot be drawn from these studies alone. Pediatric urologists are urged to conduct randomized controlled trials to compare patients followed up with and without ABP. Given the lack of guidelines, an individualized approach should be used for the use of ABP, until precise guidelines and recommendations are developed.

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“…Recently, a large multicenter, randomized study including 607 children with VUR diagnosed after the first or second UTI and with a 2-year clinical follow-up demonstrated that CAP is associated with a significant reduction in the risk of UTI episodes but not new scars (Grade of Recommendation A) (58). Recent meta-analysis have demonstrated benefits of CAP in infants with all degrees of VUR (59)(60)(61)(62).…”

Section: Continuous Antibiotics Prophylaxis (Cap)mentioning

confidence: 99%