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Antibiotic Prophylaxis for Children with UTIs

Prophylaxis was associated with a modest but significant reduction in recurrent UTI.

Recent studies have suggested that antibiotic prophylaxis following urinary tract infection (UTI) in children does not reduce the incidence of UTIs, but these studies had numerous shortcomings (JW Pediatr Adolesc Med Aug 8 2007 and JW Pediatr Adolesc Med Jun 11 2008). In a multicenter clinical trial, investigators in Australia randomized 576 children younger than 18 years (median age, 14 months; 64% female) with histories of culture-proven UTI to receive either low-dose antibiotic prophylaxis (2 mg/kg of trimethoprim plus 10 mg/kg of sulfamethoxazole) or placebo for 12 months.

During the 12-month study, children who received antibiotics were significantly less likely to develop a recurrent UTI than children who received placebo (13% vs. 19%; P=0.02). Most recurrences occurred during the first 6 months after randomization. Results on renal scans (improved, unchanged, or worsening) did not differ between the antibiotic and placebo groups at 12 months. Prophylaxis appeared to be more effective in preventing recurrent UTIs in children with grades III–V vesicoureteral reflux (absolute risk difference, 6.8%) than in those with grades I–II reflux (5.4%) or no reflux (1.8%), although this trend was not significant.

Comment: Even though this study was appropriately powered, it unfortunately focused on a proximal outcome — recurrent UTI — rather than on the outcome of true interest — long-term renal function. I concur with editorialists who stress the importance of determining the presence of vesicoureteral reflux at the time of diagnosis of UTI. Few data support the use of antibiotic prophylaxis in children with no reflux. Whether antibiotic prophylaxis after UTI in children with significant reflux preserves long-term renal function remains an unanswered question.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine October 28, 2009

Citation(s):

Craig JC et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 2009 Oct 29; 361:1748.

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• Medline abstract (Free)

Hoberman A and Keren R. Antimicrobial prophylaxis for urinary tract infection in children. N Engl J Med 2009 Oct 29; 361:1804.

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• Medline abstract (Free)