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Prophylactic antibiotics prevent UTI recurrences in children with vesicoureteral reflux
Date:5/4/2014

VANCOUVER, BRITISH COLUMBIA Children diagnosed with vesicoureteral reflux (VUR) following a urinary tract infection (UTI) are at risk for kidney scarring with subsequent UTIs. New research shows that children receiving antimicrobials over a two-year period to prevent infections (antimicrobial prophylaxis) had a substantially reduced risk of UTI recurrences compared with children receiving a placebo.

The study will be presented Sunday, May 4, at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada. The study also is published in the New England Journal of Medicine on May 4.

Normally, urine flows only down from the kidneys to the bladder. VUR is the abnormal flow of urine from the bladder back up the tubes that connect the kidneys to the bladder. VUR is present in one-third of children presenting with urinary tract infection accompanied by a fever and has been associated with a heightened risk of kidney scarring.

Earlier randomized, controlled trials that compared anti-reflux surgery with antimicrobial prophylaxis showed no differences in rates of recurrent urinary tract infection and renal scarring; however, lack of a placebo or observation group precluded a determination that either surgery or prophylaxis was effective. Recently conducted randomized trials, most unblinded, have reported conflicting results about the effectiveness of antimicrobial prophylaxis in reducing recurrences.

The aim of this study was to determine if giving children low-dose trimethoprim-sulfamethoxazole would prevent recurrent UTIs, decrease kidney scarring and contribute to the emergence of bacterial resistance. Called the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial, the study enrolled 607 children ages 2-71 months who were diagnosed with VUR following a first or second episode of UTI.

Participants were recruited from 19 clinical trial centers in the Unite
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Contact: Debbie Jacobson
djacobson@aap.org
847-434-7084
American Academy of Pediatrics
Source:Eurekalert

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