|Year : 2006 | Volume
| Issue : 4 | Page : 383
Prophylactic antibiotics in children with vesicoureteric reflux: How long is long enough?
Rajiv Goyal, Aneesh Srivastava
Departments of Urology and Renal Transplant, SGPGIMS, Lucknow, India
Departments of Urology and Renal Transplant, SGPGIMS, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goyal R, Srivastava A. Prophylactic antibiotics in children with vesicoureteric reflux: How long is long enough?. Indian J Urol 2006;22:383
Al-Sayyad AJ, Pike JG, Leonard MP. Can prophylactic antibiotics safely be discontinued in children with vesicoureteral reflux? J Urol 2005;174:1587-9.
| Summary|| |
In this retrospective analysis, authors have studied the outcome of stopping prophylactic antibiotics in a select group of patients with persistent reflux beyond a certain age group. Seventy-eight children (67 girls and 11 boys) were studied. Seventeen per cent had Grade 1, 76% Grade 2 and 7% had Grade 3 VUR. Mean patient age when taken off antibiotics was 5.74 years. The period on prophylactic antibiotics ranged from 0 to 84 months (mean 26.2) and the period off antibiotics ranged from 5 to 138 months (37.7). UTI developed in nine girls (11.5%), of whom eight had cystitis (10.2%) and one had clinically presumptive pyelonephritis (1.3%). These 9 girls were off antibiotics for five to 60 months (mean 21.1). None of our patients, including those with UTI, had new renal scarring on follow-up renal ultrasound.
| Comments|| |
Although the long-term use of antibiotics in children with vesicoureteric reflux (VUR) seems innocuous, the cost, inconvenience, possible side-effects and parental concerns may prompt discontinuation or surgical intervention. The impact of reflux on the upper tracts is more or less predictable as the risk of renal scarring with UTI is greatest in children younger than one year of age and patients with febrile UTI before four years of age have a much greater likelihood of renal scarring than older children. Prompt treatment of pyelonephritis is known to prevent renal scar formation. Thus, the concept of discontinuing prophylactic antibiotics in older children with VUR who are communicative and not greatly predisposed to UTI by dysfunctional voiding habits has a sound footing.
Similar attempts have been made by others, even in higher grades of reflux. UTI have been found to be more common in girls and mainly affecting the lower tract. Even upper tract infections did not result in new scar formation.
Discontinuing prophylactic antibiotics in select school-aged children with persistent VUR is safe practice. The risk of significant upper tract infection is low and the development of new renal scars is unlikely. Renal ultrasound seems to be reasonable for follow-up scars but DMSA scan would be an ideal investigation. Continuing surveillance of these children is necessary with parents understanding the need of further investigations like cystourethrogram and therapy if renal deterioration occurs. Further prospective randomized trials are required to substantiate this approach. As of now, one should continue with antibiotic prophylaxis either till the reflux resolves or surgical intervention is done.
| References|| |
|1.||Cooper CS, Chung BI, Kirsch AJ, Canning DA, Snyder HM 3rd. The outcome of stopping prophylactic antibiotics in older children with vesicoureteric reflux. J Urol 2000;163:269-73. [PUBMED] |
|2.||Thompson RH, Chen JJ, Pugach J, Nasser S, Steinhardt GF. Cessation of prophylactic antibiotics for managing persistent vesicoureteric reflux. J Urol 2001;166:1465-9. |