Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children

• Published in: The New England journal of medicine Vol. 361; no. 18; pp. 1748 - 1759
• Main Authors: Craig, Jonathan C, Simpson, Judy M, Williams, Gabrielle J, Lowe, Alison, Reynolds, Graham J, McTaggart, Steven J, Hodson, Elisabeth M, Carapetis, Jonathan R, Cranswick, Noel E, Smith, Grahame, Irwig, Les M, Caldwell, Patrina H.Y, Hamilton, Sana, Roy, Leslie P
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 29-10-2009
• Subjects: Adolescent; Anti-Infective Agents, Urinary - administration & dosage; Anti-Infective Agents, Urinary - adverse effects; Anti-Infective Agents, Urinary - therapeutic use; Antibacterial agents; Antibiotic Prophylaxis; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacterial diseases; Bacterial diseases of the urinary system; Biological and medical sciences; Child; Child, Preschool; Clinical medicine; Excretory system; Female; General aspects; Human bacterial diseases; Humans; Infant; Infant, Newborn; Infections; Infectious diseases; Male; Medical sciences; Patient Compliance; Pharmacology. Drug treatments; Secondary Prevention; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage; Trimethoprim, Sulfamethoxazole Drug Combination - adverse effects; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Urinary Tract Infections - epidemiology; Urinary Tract Infections - etiology; Urinary Tract Infections - prevention & control; Vesico-Ureteral Reflux - classification; Vesico-Ureteral Reflux - complications; Vesico-Ureteral Reflux - drug therapy; Human; Medicine; Chemoprophylaxis; Urinary tract infection; Relapse; Urinary system disease; Urinary tract disease; Recurrent; Antibacterial agent; Child
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa0902295

This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy would prevent urinary tract infection in children (under the age of 18 years) who had already had one or more microbiologically proven urinary tract infections. Long-term, low-dose trimethoprim–sulfamethoxazole was associated with a modest decrease in the number of urinary tract infections in predisposed children.
Long-term, low-dose trimethoprim–sulfamethoxazole was associated with a modest decrease in the number of urinary tract infections in predisposed children.
Urinary tract infection is a very common illness in children, affecting 2% of boys and 8% of girls by the age of 7 years.
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Urinary tract infection is associated with long-term morbidity, with renal damage reported in about 5% of affected children.
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The observation that urinary tract infection and vesicoureteral reflux are associated with renal damage
3
–
5
led to the standard clinical practice of assessment with voiding cystourethrography for the presence of vesicoureteral reflux in children who had had urinary tract infection
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,
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and the administration of daily low-dose antibiotics for many years
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to prevent further urinary tract infections and . . .