Antibiotic prophylaxis for prevention of febrile urinary tract infections in children with vesicoureteral reflux: a meta-analysis of randomized, controlled trials comparing dilated to nondilated vesicoureteral reflux.

Abstract

PURPOSE:

The followup and treatment of children with vesicoureteral reflux has been debated for many years. Antibiotic prophylaxis has a role for preventing urinary tract infection in these children. Recent studies and guidelines suggested that prophylaxis has little or no role in preventing urinary tract infection in those children, especially those with low grades (I and II) of reflux.

MATERIALS AND METHODS:

We analyzed all published randomized, controlled trials comparing antibiotic prophylaxis vs no prophylaxis or placebo in children with vesicoureteral reflux. The children were divided into those with nondilated (grades I and II) and dilated (grades III and IV) vesicoureteral reflux. After data were analyzed the RIVUR study was published and, therefore, it was added to the analyzed data.

RESULTS:

After analyzing the first published studies we found that antibiotic prophylaxis would be beneficial only in children with high grade vesicoureteral reflux. With the addition of the data in the RIVUR study these results changed. The new pooled data support antibiotic prophylaxis in all children with vesicoureteral reflux.

CONCLUSIONS:

Vesicoureteral reflux management is still controversial. In contrast to recently published studies and guidelines, this meta-analysis supports antibiotic prophylaxis in all children with vesicoureteral reflux regardless of reflux grade. More studies are needed to support this finding.

• Authors: Jose de Bessa Jr, Flavia Cristina de Carvalho Mrad, Evilin Feitosa Mendes, Marcia Carvalho Bessa, Victor Pereira Paschoalin, Ricardo Brianezi Tiraboschi, Zein Mohamed Sammour, Cristiano Mendes Gomes, Luis H Braga, José Murillo Bastos Netto
• Journal: The Journal of urology (J Urol) Vol. 193 Issue 5 Suppl Pg. 1772-7 (May 2015) ISSN: 1527-3792 [Electronic] United States
• PMID: 25817142 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-Infective Agents, Urinary
• Trimethoprim, Sulfamethoxazole Drug Combination

Topics

• Anti-Infective Agents, Urinary (administration & dosage)
• Antibiotic Prophylaxis
• Child
• Dilatation, Pathologic
• Female
• Fever (epidemiology)
• Humans
• Male
• Treatment Outcome
• Trimethoprim, Sulfamethoxazole Drug Combination (administration & dosage)
• Urinary Tract Infections (epidemiology, prevention & control)
• Vesico-Ureteral Reflux (epidemiology, pathology)