Rapid Response

Is Routine Antimicrobial Prophylaxis Justifiable in Prepubescent Children With Recurrent Urinary Tract Infections?

Authors: Marc Smaldone, MD, Danielle Sweeney, MD, Benjamin J. Davies, MD

Abstract

Is Routine Antimicrobial Prophylaxis Justifiable in Prepubescent Children With Recurrent Urinary Tract Infections?


The natural course of urinary tract infections (UTI) in children is unpredictable, and management is controversial. Of the 3% and 1% of prepubescent girls and boys diagnosed with a UTI, up to 17% have infection-related renal scarring.1 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. The current American Academy of Pediatrics practice guidelines for management of children (<2 years) after a first UTI recommend an imaging study to evaluate for vesicoureteral reflux (VUR) and subsequent initiation of daily antimicrobial prophylaxis to prevent recurrent UTIs.2 However, despite the fact that VUR is common in children with UTIs, there is no proven correlation between VUR and susceptibility to UTI or that prophylaxis will prevent future renal scarring.3

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References

1. Winberg J, Andersen HJ, Bergstrom T, et al. Epidemiology of symptomatic urinary tract infection in childhood. Acta Paediatr Scand 1974;Suppl:1.
 
2. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics, 1999;103:843–852.
 
3. Jodal U, Smellie JM, Lax H, et al. Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the International Reflux Study in Children. Pediatr Nephrol 2006;21:785–792.
 
4. Garin EH, Olavarria F, Garcia Nieto V, et al. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 2006;117:626–632.
 
5. Conway PH, Cnaan A, Zaoutis T, et al. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 2007;298:179–186.