May we go on with antibacterial prophylaxis for urinary tract infections?

Abstract

Recurrent urinary tract infections (UTIs), with or without vesicoureteric reflux (VUR), are by far the most frequent reason for long-term antibacterial prophylaxis in infants and children today. However, the strategies of antibacterial prophylaxis for the prevention of recurrent urinary tract infection are no longer universally accepted. In infants and children at risk, the benefits of antibacterial prophylaxis definitively are not yet proven by evident data. To put antibacterial prophylaxis in its place, risk groups for recurrent symptomatic infections, ascending UTI and permanent renal damage have to be defined and the efficacy of prophylaxis in these groups has to be proved by prospective randomised studies. Nevertheless, until the results of these studies are available, antibacterial prophylaxis will remain one of the most frequently practised methods to protect risk patients from pyelonephritic damage and UTI recurrences.

Childhood Recurrent Urinary Tract Infection in Southern Thailand

“…GU anomalies, including voiding dysfunction, contribute to urine stasis, which is a major factor of both UTI and recurrent UTI. 13 Our study showed that once UTI occurs in a child, the chance of recurrence is almost 20% in both boys and girls. GU anomalies, especially VUR, were the most significant independent risk factors.…”

“…Some studies have questioned the efficacy of antibiotic prophylaxis in patients with recurrent UTI, 6,13 but to date, none have been conclusive. One meta-analysis review concluded that antibiotic prophylaxis "may not" prevent recurrent symptomatic UTI on children.…”

Urinary tract infections: to prophylaxis or not to prophylaxis?

“…Searching the literature up to 2006, an extensive editorial commentary in this journal [9] reported that, while the strategies of antibacterial prophylaxis for the prevention of recurrent urinary tract infection were no longer universally accepted, recurrent urinary tract infections, with or without reflux, remained the most frequent reason for long-term antibacterial prophylaxis in infants and children. A recent Cochrane review [10] concluded that the small number of poor quality studies gave no reliable evidence of the effectiveness of antibiotics in preventing recurrent symptomatic UTIs.…”

Antibacterial prophylaxis in primary vesicoureteral reflux

“…Lebensjahrs die antibakterielle Infektionsprophylaxe auch bei persistierendem VUR versuchsweise zu beenden. Dies gilt insbesondere für Kinder mit niedriggradigen VUR (I-III) [2].…”