Navigation Links
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 United States and underwent kidney scans to determine if scarring was present at baseline. Then they were randomized to receive trimethoprim-sulfamethoxazole or a placebo; kidney scans were repeated at one and two years.

Results showed that 39 of 302 children (13 percent) receiving antimicrobial prophylaxis developed UTIs compared to 72 of 305 (24 percent) receiving placebo. Antimicrobial prophylaxis reduced the risk of infections by 50 percent compared with placebo.

Prophylaxis was most effective in children who had a fever with their initial UTI and in those with bladder and bowel dysfunction at baseline. The occurrence of kidney scarring did not differ between the two groups (12 percent for the treatment group vs. 10 percent for the placebo group).

"Rates of renal scarring at the outcome visit were low and not reduced by prophylaxis, perhaps because most children were enrolled after their first infection and because parents, instructed to be vigilant, sought early medical attention," said lead author Alejandro Hoberman, MD, FAAP, chief of the Division of General Academic Pediatrics at Children's Hospital of Pittsburgh and professor of pediatrics at University of Pittsburgh School of Medicine. "Not unexpectedly, recurrences that did occur in children who received prophylaxis were more likely to have been caused by a resistant pathogen."

"This study showed unequivocal evidence that antimicrobial prophylaxis reduced at least in half the likelihood of children having recurrent UTIs," Dr. Hoberman concluded. "Some subgroups of children derived the most benefit, particularly those with bladder and bowel dysfunction at baseline, and those in whom the UTI occurred with fever."

Dr. Hoberman will present "Results from the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial" from 5:30-5:45 p.m. Sunday, May 4. To view the study abstract, go to http://www.abstracts2view.com/pas/view.php?nu=PAS14L1_2823.9&terms=.


'/>"/>

Contact: Debbie Jacobson
djacobson@aap.org
847-434-7084
American Academy of Pediatrics
Source:Eurekalert

Related medicine news :

1. PharmaPoint: Pediatric Respiratory Syncytial Virus (RSV) Prophylactics - Current and Future Players
2. PharmaPoint: Pediatric Respiratory Syncytial Virus (RSV) Prophylactics - US Drug Forecast and Market Analysis to 2022
3. Antibiotics alone are a successful treatment for uncomplicated acute appendicitis in kids
4. LA BioMed study finds daily antibiotics most effective in preventing recurrent urinary tract infection
5. Antibiotics before heart surgery protect against infection
6. Penicillin equally effective as big gun antibiotics for treating less severe childhood pneumonia
7. New Guidance Limits Antibiotics for Common Infections in Children
8. Aqua Feed Market (Antibiotics, Vitamins, Antioxidants, Amino Acids, Feed Enzymes, Feed Acidifiers) Worth $106 Billion By 2018 - New Report by MarketsandMarkets
9. Antibiotics Procurement Research Report Now Available from IBISWorld
10. Alternative to antibiotics
11. Zithromax Antibiotics Arrhythmia Lawsuits Help: Resource4thePeople Urges Consumers to Review Dangerous Side Effects Outlined by Medical Experts
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... Austin, TX (PRWEB) , ... June 25, 2016 , ... ... Fellow of the American College of Mohs Surgery and to Dr. Russell Peckham for ... popular and highly effective treatment for skin cancer. The selective fellowship in Mohs Micrographic ...
(Date:6/25/2016)... ... June 25, 2016 , ... First Choice Emergency ... named Dr. Sesan Ogunleye, as the Medical Director of its new Mesquite-Samuell Farm facility. ... Director of our new Mesquite location,” said Dr. James M. Muzzarelli, Executive Medical Director ...
(Date:6/25/2016)... ... June 25, 2016 , ... On Friday, June 10, Van Mitchell, Secretary ... Work award to iHire in recognition of their exemplary accomplishments in worksite health promotion. ... Maryland Workplace Health & Wellness Symposium at the BWI Marriott in Linthicum Heights. iHire ...
(Date:6/24/2016)... ... June 24, 2016 , ... Those who have experienced traumatic events ... turn to unhealthy avenues, such as drug or alcohol abuse, as a coping mechanism. ... tools for healthy coping following a traumatic event. , Trauma sufferers tend to feel ...
(Date:6/24/2016)... ... June 24, 2016 , ... ... Sessions in Dallas that it will receive two significant new grants to support ... as PHA marked its 25th anniversary by recognizing patients, medical professionals and scientists ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... -- Bracket , a leading clinical trial technology and ... platform, Bracket eCOA (SM) 6.0, at the 52 nd ... 2016 in Philadelphia , Pennsylvania.  A demonstration ... of its kind to fully integrate with RTSM, will be ... is a flexible platform for electronic clinical outcomes assessments that ...
(Date:6/23/2016)... Revolutionary technology includes multi-speaker listening to conquer ... in advanced audiology and hearing aid technology, has today ... world,s first internet connected hearing aid that opens up ...      (Photo: http://photos.prnewswire.com/prnh/20160622/382240 ) , ... , TwinLink™ - the first dual communication ...
(Date:6/23/2016)... , June 23, 2016  Experian Health, ... and transforming the patient payment and care ... innovative new products and services that will ... revenue cycle offerings. These award-winning solutions will ... workflows, remain compliant in an ever-changing environment ...
Breaking Medicine Technology: