title: Antibiotic prophylaxis for prevention of febrile urinary tract infections in children with vesicoureteral reflux: a meta-analysis of randomized, controlled trials comparing dilated to nondilated vesicoureteral reflux.
abstract: OBJECTIVE
  The followup and treatment of children with vesicoureteral reflux has been debated for many years. Antibiotic prophylaxis has a role for preventing urinary tract infection in these children. Recent studies and guidelines suggested that prophylaxis has little or no role in preventing urinary tract infection in those children, especially those with low grades (I and II) of reflux.
  
  
  METHODS
  We analyzed all published randomized, controlled trials comparing antibiotic prophylaxis vs no prophylaxis or placebo in children with vesicoureteral reflux. The children were divided into those with nondilated (grades I and II) and dilated (grades III and IV) vesicoureteral reflux. After data were analyzed the RIVUR study was published and, therefore, it was added to the analyzed data.
  
  
  RESULTS
  After analyzing the first published studies we found that antibiotic prophylaxis would be beneficial only in children with high grade vesicoureteral reflux. With the addition of the data in the RIVUR study these results changed. The new pooled data support antibiotic prophylaxis in all children with vesicoureteral reflux.
  
  
  CONCLUSIONS
  Vesicoureteral reflux management is still controversial. In contrast to recently published studies and guidelines, this meta-analysis supports antibiotic prophylaxis in all children with vesicoureteral reflux regardless of reflux grade. More studies are needed to support this finding.
authors: Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada. Electronic address: bessa.jr@terra.com.br.
authors: Jose
authors: J
authors: de Bessa
authors: Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
authors: Flavia Cristina
authors: FC
authors: de Carvalho Mrad
authors: Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
authors: Evilin Feitosa
authors: EF
authors: Mendes
authors: Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
authors: Marcia Carvalho
authors: MC
authors: Bessa
authors: Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
authors: Victor Pereira
authors: VP
authors: Paschoalin
authors: Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
authors: Ricardo Brianezi
authors: RB
authors: Tiraboschi
authors: Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
authors: Zein Mohamed
authors: ZM
authors: Sammour
authors: Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
authors: Cristiano Mendes
authors: CM
authors: Gomes
authors: Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
authors: Luis H
authors: LH
authors: Braga
authors: Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
authors: José Murillo
authors: JM
authors: Bastos Netto
mesh_terms: D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002648:Child; D004108:Dilatation, Pathologic; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology* / Q000473:pathology
chemical_list: D000892:Anti-Infective Agents, Urinary; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: antibiotic prophylaxis; kidney; pyelonephritis; urinary tract infections; vesico-ureteral reflux