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Do Prophylactic Antibiotics Prevent Children’s UTIs?

In a large multicenter study, prophylactic antibiotics did not prevent recurrent urinary tract infections in children.

In the U.S., an estimated 70,000 to 180,000 children (3%–7% of girls, 1%–2% of boys) develop a urinary tract infection (UTI) by age 6. Guidelines recommend imaging to evaluate for the presence and degree of vesicoureteral reflux (VUR; thought to increase the risk for renal scarring) and, for children with VUR, prophylactic antibiotics to prevent recurrent infections. However, data are limited regarding the risk factors for recurrent UTIs in children and the risks and benefits of antibiotic prophylaxis. To shed light on these issues, investigators analyzed records from 27 primary care pediatric practices linked by a common electronic health record system.

Of 74,974 children aged 6 in the network, 611 were diagnosed with a first UTI — and had at least one additional clinic visit 24 days after diagnosis — between July 2001 and May 2006. Among these children, 83 had a recurrent UTI (recurrent UTI incidence rate, 0.12 per person-year). Factors significantly associated with risk for recurrence included white race, age 3–4 or 4–5, and grade 4 or 5 VUR. Antibiotic prophylaxis was not associated with decreased risk for recurrent UTI; instead, it was associated with a significantly increased risk for infection with an antimicrobial-resistant organism (hazard ratio, 7.5; 95% confidence interval, 1.6–35.2).

Comment: Pediatricians routinely prescribe prophylactic antibiotics for infants and children with significant VUR. These findings suggest that VUR grades 1 to 3 do not increase risk for recurrent UTI and that in VUR grades 4 and 5, prophylactic antibiotics may be ineffective in preventing recurrence. Dropping prophylactic antibiotics for children with first UTI and demonstrated VUR would be a good step in reducing unnecessary antibiotic use.

— Robert S. Baltimore, MD

Published in Journal Watch Infectious Diseases July 25, 2007

Citation(s):

Conway PH et al. Recurrent urinary tract infections in children: Risk factors and association with prophylactic antimicrobials. JAMA 2007 Jul 11; 298:179-86.

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