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:2/11/2016)... ... February 11, 2016 , ... According to an article ... as a weight loss dietary supplement, is being recalled due to the discovery that ... because there is not a single supplement on the market proven to help people ...
(Date:2/11/2016)... ... February 11, 2016 , ... Dr. Sadati’s recent feature ... procedures. Along with performing procedures, the magazine also highlights that Dr. Sadati has ... One of the most common procedures he performs is his natural facelift. “As ...
(Date:2/11/2016)... (PRWEB) , ... February 11, 2016 , ... The president ... DoD Military Health System but would shift more of the cost burden to military ... TRICARE-reform plan laid out in the defense budget as including limited quantifiable benefit fixes ...
(Date:2/11/2016)... (PRWEB) , ... February 11, 2016 , ... ... surgery, dermatology and women’s health, is pleased to announce the promotions of Allison ... Partners sales team, Steve Catone to executive vice president of North American capital ...
(Date:2/11/2016)... Laurel, NJ (PRWEB) , ... February 11, 2016 ... ... announces the call for nominations seeking candidates for the Board of Commissioners. Individuals ... with passion, skills and experience with diversity of clinical practice settings and across ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... Feb. 11, 2016 Brain Cancer patients ... method at West Cancer Center . Optune™, ... to inhibit cancer cell replication causing death of cancer ... a decade to show a significant extension in overall ... patients. Currently, West Cancer Center is the only medical ...
(Date:2/11/2016)... 2016 Jeffrey Zucker , vice ... will present at this year,s Summit for Clinical Operations Executives ... Miami, FL. Zucker will discuss how ... execution, supporting SCOPE,s "Improving Site Study Activation and Performance" portion ... Feb. 25 at 11:05 a.m. --> ...
(Date:2/11/2016)... Ohio , Feb. 11, 2016  Community pharmacists ... increasing efficiency for the pharmacy through a custom-built medication ... Schieber , pharmacist and owner at Schieber Family ... "We can get a lot of patients enrolled in ... for everybody. It,s a win for the patient, and ...
Breaking Medicine Technology: