Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report on the Management of Primary Vesicoureteral Reflux in Children

Elder, Jack S.; Peters, Craig A.; Arant, Billy S.; Ewalt, David H.; Hawtrey, Charles E.; Hurwitz, Roger A.; Parrott, Thomas S.; Snyder, Howard M.; Weiß, Robert; Woolf, Steven H.; Hasselblad, Vic

doi:10.1016/s0022-5347(01)64882-1

Cited by 538 publications

(110 citation statements)

References 8 publications

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“…The well-known association between VUR and UTI has led to the concept that VUR plays a pathogenetic role in the development of UTI, acute pyelonephritis and renal scars. Children with VUR are usually given prophylactic antibiotics 9 10. In our subgroup analysis, we found that long-term antibiotic prophylaxis in children with VUR was not related to a decrease in recurrent symptomatic UTI.…”

Section: Discussionmentioning

confidence: 60%

“…Renal involvement in the acute phase of infection and subsequent scarring may lead to the development of chronic renal impairment and hypertension 7 8. Long-term antibiotic prophylaxis has for many years been given to children at risk for UTI, especially those with vesicoureteric reflux (VUR), a condition present in approximately 30–40% of children with UTI 9 10. However, this recommendation is based on expert opinion rather than clear scientific evidence.…”

Section: Introductionmentioning

confidence: 99%

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Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta-analysis

Dai

Liu

Jia

et al. 2010

Archives of Disease in Childhood

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta-analysis

Dai

Liu

Jia

et al. 2010

Archives of Disease in Childhood

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“…The upper age was subsequently shown to be about 4 years by using dimercaptosuccinic acid (DMSA) scans which detect scars immediately they occur 11. It was widely assumed (including by the authors at the time) that as well as reflux tending to resolve with time,12 human kidneys must also mature in such a way that they lose their vulnerability to scarring by 4 years of age. However, this view has now been challenged in a way which, if sustained, will have major implications.…”

mentioning

confidence: 99%

Is reflux nephropathy preventable, and will the NICE childhood UTI guidelines help?

Coulthard

2008

Archives of Disease in Childhood

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“…Surgical reimplantation has general risks of anaesthetic use, postoperative infection, and ureteric obstruction. 8 There is increasing concern about the development of antibiotic resistant bacteria following long term antibiotic use. 9 Quantifying these potential harms is problematic.…”

mentioning

confidence: 99%

Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials

Wheeler

Vimalachandra²,

Hodson³

et al. 2003

Archives of Disease in Childhood

176

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Aims: To evaluate the benefits and harms of treatments for vesicoureteric reflux in children. Methods: Meta-analyses of randomised controlled trials using a random effects model. Main outcome measures were incidence of urinary tract infection (UTI), new or progressive renal damage, renal growth, hypertension, and glomerular filtration rate. Results: Eight trials involving 859 evaluable children comparing long term antibiotics with surgical correction of reflux (VUR) and antibiotics (seven trials) and antibiotics compared with no treatment (one trial) were identified. Risk of UTI by 1-2 and 5 years was not significantly different between surgical and medical groups (relative risk (RR) by 2 years 1.07; 95% confidence interval (CI) 0.55 to 2.09, RR by 5 years 0.99; 95% CI 0.79 to 1.26). Combined treatment resulted in a 60% reduction in febrile UTI by 5 years (RR 0.43; 95% CI 0.27 to 0.70) but no concomitant significant reduction in risk of new or progressive renal damage at 5 years (RR 1.05; 95% CI 0.85 to 1.29). In one small study no significant differences in risk for UTI or renal damage were found between antibiotic prophylaxis and no treatment. Conclusion: It is uncertain whether the identification and treatment of children with VUR confers clinically important benefit. The additional benefit of surgery over antibiotics alone is small at best. Assuming a UTI rate of 20% for children with VUR on antibiotics for five years, nine reimplantations would be required to prevent one febrile UTI, with no reduction in the number of children developing any UTI or renal damage. P rimary vesicoureteric reflux is thought to be caused by a maturational abnormality of the vesicoureteric junction, so that urine passes in a retrograde manner up the ureter. Although the exact prevalence in the general childhood population is unknown, about a third of children with urinary tract infection are consistently found to have reflux.1 Urinary tract infection occurs in approximately 5-10% of children, and so 1-3% of children are identified with vesicoureteric reflux.

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Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report on the Management of Primary Vesicoureteral Reflux in Children

Abstract: For most children the panel recommended continuous antibiotic prophylaxis as initial treatment. Surgery was recommended for children with persistent reflux and other indications, as specified in the document.

Cited by 538 publications

References 8 publications

Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta-analysis

Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta-analysis

Is reflux nephropathy preventable, and will the NICE childhood UTI guidelines help?

Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials

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