Antibiotic prophylaxis for childhood urinary tract infections

[kkmalaysia]

By the age of 7, some 8% of girls and 2% of boys have had a urinary tract infection, and around one in 20 of these will have renal damage. It is not known whether long-term antibiotic prophylaxis prevents renal damage. Now, a multicenter trial in Australia has shown that such prophylaxis prevents some recurrent urinary tract infections.

A 12-month randomized trial of trimethoprimsulfamethoxazole suspension vs placebo included 576 children (77% <4 years old) with at least one previous urinary tract infection. Vesicoureteric reflux had been diagnosed in 42%. Recurrent urinary tract infection occurred during the trial in 13% (treatment group) vs 19% (controls), a significant difference. The number-needed-to-treat to prevent one urinary tract infection was 14.

Long-term antibiotic prophylaxis with trimethoprim-sulfamethoxazole was modestly effective.

Craig JC et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. NEJM 2009; 361:1748–1759; Hoberman A, Keren R. Antimicrobial prophylaxis for urinary tract infection in children. Ibid:1804– 1806 (editorial).