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

d 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

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

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