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Antibiotic Prophylaxis Is Not Effective for Vesicoureteral Reflux

In a randomized, controlled trial, antibiotic prophylaxis did not reduce recurrence of pyelonephritis or occurrence of renal scars.

The efficacy of antibiotic prophylaxis in children with vesicoureteral reflux (VUR) following a diagnosis of pyelonephritis remains controversial. In this multicenter trial from Italy, 100 children (age range, 1 day to 30 months) with VUR (grades II–IV) and a first diagnosis of acute pyelonephritis (fever, positive urinalysis, and 2 positive urine cultures) were randomized to receive antibiotic prophylaxis (sulfamethoxazole/trimethoprim) or no treatment for 2 years.

No statistically significant differences in recurrence of pyelonephritis (the primary outcome) were noted between the treatment and control groups during 2 years of prophylaxis (36% vs. 30%) or at follow-up 2 years after prophylaxis (2% vs. 4%). The presence of renal scars after 2 years of prophylaxis also was similar in the two groups (40% vs. 36%, respectively).

Comment: Although it is debatable whether all the study children had pyelonephritis, the results of this study, combined with those of a recent large cohort study (JW Pediatr Adolesc Med Aug 8 2007), add to a growing body of evidence demonstrating that antibiotic prophylaxis is not indicated in children diagnosed with pyelonephritis and VUR grades II to IV.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine June 11, 2008

Citation(s):

Pennesi M et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics 2008 Jun; 121:e1489. (http://dx.doi.org/10.1542/peds.2007-2652)

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