title: Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study.
abstract: OBJECTIVE
  To evaluate the role of primary vesicoureteral reflux (VUR) in increasing the frequency and severity of urinary tract infections (UTIs) and renal parenchymal damage among patients with acute pyelonephritis and to determine whether urinary antibiotic prophylaxis reduces the frequency and/or severity of UTIs and/or prevents renal parenchymal damage among patients with mild/moderate VUR.
  
  
  METHODS
  Patients 3 months to 18 years of age with acute pyelonephritis, with or without VUR, were assigned randomly to receive urinary antibiotic prophylaxis or not. Patients were monitored every 3 months for 1 year. Dimercaptosuccinic acid renal scans were repeated at 6 months or if there was a recurrence of febrile UTI. Urinalysis and urine culture were performed at each clinic visit. Renal ultrasound scans and voiding cystourethrograms were repeated at the end of 1 year of follow-up monitoring.
  
  
  RESULTS
  Of the 236 patients enrolled in the study, 218 completed the 1-year follow-up monitoring. Groups were similar with respect to age, gender, and reflux grade distribution for those with VUR. No statistically significant differences were found among the groups with respect to rate of recurrent UTI, type of recurrence, rate of subsequent pyelonephritis, and development of renal parenchymal scars.
  
  
  CONCLUSIONS
  After 1 year of follow-up monitoring, mild/moderate VUR does not increase the incidence of UTI, pyelonephritis, or renal scarring after acute pyelonephritis. Moreover, a role for urinary antibiotic prophylaxis in preventing the recurrence of infection and the development of renal scars is not supported by this study.
authors.affiliation: Department of Pediatrics, University of South Florida, Tampa, Florida, USA. garineh@peds.ufl.edu
authors.forename: Eduardo H
authors.initials: EH
authors.lastname: Garin
authors.forename: Fernando
authors.initials: F
authors.lastname: Olavarria
authors.forename: Victor
authors.initials: V
authors.lastname: Garcia Nieto
authors.forename: Blanca
authors.initials: B
authors.lastname: Valenciano
authors.forename: Alfonso
authors.initials: A
authors.lastname: Campos
authors.forename: Linda
authors.initials: L
authors.lastname: Young
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D011704:Pyelonephritis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D011877:Radionuclide Imaging; D012008:Recurrence; D016896:Treatment Outcome; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000000981:diagnostic imaging