title: Antibiotics for the prevention of urinary tract infection in children: A systematic review of randomized controlled trials.
abstract: OBJECTIVE
  The objective was to evaluate the effectiveness of low-dose, long-term antibiotics for the prevention of symptomatic urinary tract infection (UTI) in children.
  
  
  METHODS
  This was a systematic review of randomized controlled trials with a random effects model meta-analysis.
  
  
  METHODS
  Five trials involving 463 children were performed.
  
  
  RESULTS
  Three trials (n = 392) evaluated the effectiveness of long treatment courses of antibiotics (2 to 6 months) for children with acute UTI to prevent subsequent, off-treatment infection. Only 2 trials (n = 71) evaluated the effectiveness of long-term, low-dose antibiotics to prevent on-treatment UTI. Very few of the children enrolled in the trials were boys, had abnormal renal tracts, or were infants. The trial quality was poor, with a lack of blinding, and unstated UTI definitions were almost universal. Long-term antibiotic administration reduced the risk of UTI with treatment (relative risk 0.31, 95% confidence limits 0.10 to 1.00), but there was significant heterogeneity (Q = 13.45, P <.01), and there was no sustained benefit once antibiotics had ceased (relative risk 0.79, 0.61 to 1.02).
  
  
  CONCLUSIONS
  Methodologic and applicability problems with published trials mean that there is considerable uncertainty about whether long-term, low-dose antibiotic administration prevents UTI in children. Well-designed, randomized, placebo-controlled trials are still required to evaluate this commonly used intervention.
authors.affiliation: Centre for Kidney Research, Royal Alexandra Hospital for Children, Sydney, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Williams
authors.forename: A
authors.initials: A
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Craig
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents