title: Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: systematic review and meta-analysis.
abstract: OBJECTIVE
  Controversy exists regarding the use of continuous antibiotic prophylaxis vs observation in the management of children with vesicoureteral reflux. The reported effectiveness of continuous antibiotic prophylaxis in children with reflux varies widely. We determined whether the aggregated evidence supports use of continuous antibiotic prophylaxis in children with vesicoureteral reflux.
  
  
  METHODS
  We searched the Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE(®), EMBASE(®), Google Scholar and recently presented meeting abstracts for reports in any language. Bibliographies of included studies were then hand searched for any missed articles. The study protocol was prospectively registered at PROSPERO (No. CRD42014009639). Reports were assessed and data abstracted in duplicate, with differences resolved by consensus. Risk of bias was assessed using standardized instruments.
  
  
  RESULTS
  We identified 1,547 studies, of which 8 are included in the meta-analysis. Pooled results demonstrated that continuous antibiotic prophylaxis significantly reduced the risk of recurrent febrile or symptomatic urinary tract infection (pooled OR 0.63, 95% CI 0.42-0.96) but, if urinary tract infection occurred, increased the risk of antibiotic resistant organism (pooled OR 8.75, 95% CI 3.52-21.73). A decrease in new renal scarring was not associated with continuous antibiotic prophylaxis use. Adverse events were similar between the 2 groups. Significant heterogeneity existed between studies (I(2) 50%, p = 0.03), specifically between those trials with significant risk of bias (eg unclear protocol descriptions and/or lack of blinding).
  
  
  CONCLUSIONS
  Compared to no treatment, continuous antibiotic prophylaxis significantly reduced the risk of febrile and symptomatic urinary tract infections in children with vesicoureteral reflux, although it increased the risk of infection due to antibiotic resistant bacteria. Continuous antibiotic prophylaxis did not significantly impact the occurrence of new renal scarring or reported adverse events.
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Hsin-Hsiao S
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Division of Pediatric Nephrology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Rasheed A
authors.initials: RA
authors.lastname: Gbadegesin
authors.affiliation: Division of Pediatric Nephrology, Duke University Medical Center, Durham, North Carolina.
authors.forename: John W
authors.initials: JW
authors.lastname: Foreman
authors.affiliation: Division of Pediatric Nephrology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Shashi K
authors.initials: SK
authors.lastname: Nagaraj
authors.affiliation: Division of Pediatric Nephrology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Delbert R
authors.initials: DR
authors.lastname: Wigfall
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: John S
authors.initials: JS
authors.lastname: Wiener
authors.affiliation: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: Jonathan.Routh@duke.edu.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
mesh_terms: D019072:Antibiotic Prophylaxis; D006801:Humans; D014552:Urinary Tract Infections / Q000209:etiology* / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000150:complications*
keywords: antibiotic prophylaxis; meta-analysis; pediatrics; review; vesico-ureteral reflux