Abstract

The natural course of urinary tract infections (UTI) in children is unpredictable and management is controversial. Of the 3% of prepubescent girls and 1% of boys diagnosed with a UTI, up to 17% have infection-related renal scarring. In their recent report, Conway et al present compelling data to support the theory that the risk of antimicrobial prophylaxis contributing to antimicrobial resistance may be greater than the benefit of preventing recurrent UTIs. This well-designed study adds to the body of evidence that routine use of antibiotic prophylaxis may contribute to the increasing prevalence of bacterial resistance. Rapid diagnosis of a UTI is essential to initiating rapid antimicrobial treatment to minimize acute renal damage and to prevent future renal damage from subsequent infections. Antimicrobial prophylaxis should be tailored by spectrum and duration to limit the development of bacterial resistance.