title: Is antibiotic prophylaxis effective in preventing urinary tract infections in patients with vesicoureteral reflux?
abstract: The main concern in the management of children with vesicoureteral reflux (VUR) is the prevention of urinary tract infections and avoidance of renal damage. Medical management has been recommended or preferentially suggested over surgery in all but a few select clinical situations. Prophylactic antibiotics are prescribed routinely in the management of young children with radiological evidence of VUR following an episode of acute pyelonephritis. Prophylaxis is generally maintained until the VUR resolves spontaneously or is corrected surgically. Although the administration of prophylactic antibiotics has been universal in children with VUR, some authors have reported that long-term antibiotic prophylaxis does not fully prevent urinary tract infections or scarring, that antibiotic-related adverse events are known to occur, and that the incidence of pyelonephritis does not increase in spite of prophylactic antibiotic cessation. Recently, four prospective, randomized, controlled trials of antibiotic prophylaxis for preventing pyelonephritis and renal scarring were reported and some placebo-controlled, double-blind prospective studies are ongoing. The goal of this review is to evaluate the treatment of VUR using antibiotic prophylaxis, and its advantages and disadvantages based on appropriate descriptions and studies in the literature.
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. yutaro@med.nagoya-cu.ac.jp
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kojima
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kamisawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Imura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mizuno
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kohri
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000188:drug therapy / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents