Could prophylactic antibiotics be stopped in patients with history of vesicoureteral reflux?
OBJECTIVE
To compare the incidence and type of urinary tract infection (UTI) in patients with primary vesicoureteral reflux (VUR) diagnosed after a febrile UTI while they were on prophylactic antibiotics (PA) and after stopping PA.


METHODS
Criteria to discontinue PA were: no UTI during 12+ or more months on PA, old enough to communicate UTI symptoms, potty trained and absence of risk factors for UTI. Patients with at least 1 year of follow up without PA were included (n=77). We recorded: age at which PA was indicated and stopped, time on and off PA, incidence and type of UTI (cystitis vs acute pyelonephritis (APN)), and renal scan results.


RESULTS
PA was started and stopped at a mean age of 18.5 and 61 months, respectively. Mean time on PA was 39 months (range 12-95): 25 patients had 44 UTI episodes (0.17 episodes/patient/year), and 31 (70%) of them were APN. Mean time of antibiotics was 44.5 months (range 12-162): 13 patients had 24 UTI episodes (0.08 episodes/patient/year), eight (33%) of which were APN (P<0.05). A renal scan was performed in 71 patients after the index infection and repeated in 12. Two patients lost renal function while still on PA.


CONCLUSIONS
Discontinuing PA in patients with history of VUR is a safe practice and should be considered as a management option.
Department of Pediatrics, Division of Pediatric Nephrology, Hospital Interzonal General de Agudos Dr Jose Penna, Lainez 2401, Bahía Blanca, 8000 Buenos Aires, Argentina. alconcher@speedy.com.ar
Laura F
LF
Alconcher
Maria B
MB
Meneguzzi
Roberto
R
Buschiazzo
Lisandro A
LA
Piaggio
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D011446:Prospective Studies; D012720:Severity of Illness Index; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000150:complications*
D000900:Anti-Bacterial Agents