Antimicrobial Prophylaxis for Children with Vesicoureteral Reflux

• Published in: The New England journal of medicine Vol. 370; no. 25; pp. 2367 - 2376
• Main Authors: Hoberman, Alejandro, Greenfield, Saul P, Mattoo, Tej K, Keren, Ron, Mathews, Ranjiv, Pohl, Hans G, Kropp, Bradley P, Skoog, Steven J, Nelson, Caleb P, Moxey-Mims, Marva, Chesney, Russell W, Carpenter, Myra A
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 19.06.2014
• Subjects: Anti-Infective Agents, Urinary - therapeutic use; Antimicrobial agents; Antimicrobial resistance; Biological and medical sciences; Child; Child, Preschool; Children; Diabetes mellitus; Double-Blind Method; Drug Resistance, Microbial; Drug therapy; Female; Fever - prevention & control; General aspects; Humans; Infant; Infections; Intestine; Kaplan-Meier Estimate; Kidney - pathology; Male; Medical sciences; Nephrology. Urinary tract diseases; Pediatrics; Prophylaxis; Recurrent infection; Renal failure; Secondary Prevention; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Urinary system involvement in other diseases. Miscellaneous; Urinary tract; Urinary Tract Infections - prevention & control; Urinary tract. Prostate gland; Urine; Urogenital system; Vesico-Ureteral Reflux - complications; Vesico-Ureteral Reflux - drug therapy; United States > US; Pittsburgh Pennsylvania; Human; Prevention; Medicine; Chemoprophylaxis; Urinary system disease; Vesicoureteral reflux; Bladder disease; Urinary tract disease; Child
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1401811

In this placebo-controlled trial in children with vesicoureteral reflux after a first or second febrile or symptomatic urinary tract infection, antimicrobial prophylaxis was associated with a substantially reduced risk of recurrence but not of renal scarring. Vesicoureteral reflux is present in one third of children presenting with febrile urinary tract infection and has been associated with a heightened risk of renal scarring. 1 Early randomized, controlled trials that compared antireflux surgery with antimicrobial prophylaxis showed no significant differences in the rates of recurrent urinary tract infection (recurrences) and renal scarring 2 – 5 ; however, the lack of a placebo or observation group precluded a determination that either surgery or prophylaxis was effective. More recent randomized trials, most of which were unblinded, have had conflicting results regarding the effectiveness of antimicrobial prophylaxis in reducing recurrences. 6 – 11 We designed the . . .