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Antibiotics to prevent children's recurrent urinary tract infections have unclear benefits and potential risks

The American Academy of Pediatrics (AAP) recommends an imaging study after a child's first urinary tract infection (UTI) to detect vesicoureteral reflux (VUR). In VUR, which affects 30 to 40 percent of children with UTI, urine flows backwards from the bladder back up into the kidneys. If the child has VUR, the AAP recommends daily antibiotic prophylaxis to prevent recurrent UTIs. However, recent clinical trials have not shown a protective effect of this approach for preventing recurrent UTI and kidney scarring. Moreover, a new study raises concerns about the potential of this approach to breed antibiotic-resistant bacteria that can cause recurrent UTIs.

A team led by Patrick H. Conway, M.D., M.Sc., of the University of Pennsylvania and funded by the Center for Education and Research on Therapeutics, studied children (age 6 years and under) in a network of 27 primary care pediatric practices spanning 3 States. Of 74,974 children within the network, 611 had a first UTI and 83 had a recurrent UTI during the study period. The researchers examined risk factors for recurrent UTI and the association between antibiotic prophylaxis and recurrent UTI.

Prophylactic use of antibiotics was not associated with decreased risk of recurrent UTI, but was associated with increased risk of antibiotic resistance among children with recurrent UTI. White race correlated with double the risk of recurrent UTI, age 3 to 4 years nearly triple the risk, and age 4 to 5 years correlated with 2.5 times the risk of recurrent UTI. Mild VUR (grade 1-3) was not associated with increased recurrence risk but severe VUR (grade 4-5) was.

The researchers concluded that the unclear benefits and potential risks of prophylaxis should be discussed with families and that more studies are needed to better understand this issue. Their study was supported in part by the Agency for Healthcare Research and Quality (HS10399).

More details are in "Recurrent urinary tract infections in children: Risk factors and association with prophylactic antimicrobials," by Dr. Conway, Avital Cnaan, Ph.D., Theoklis Zaoutis, M.D., M.S.C.E., and others, in the July 11, 2007, Journal of the American Medical Association 298(2), pp. 179-186.

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