title: Probiotics prophylaxis in pyelonephritis infants with normal urinary tracts.
abstract: BACKGROUND
  Pyelonephritis in infants is considered as a major factor for the formation of renal scar. To prevent recurrent pyelonephritis and renal damage, prophylaxis is extremely important. The aim of this study was to compare the effectiveness of probiotic and antibiotic prophylaxis or no-prophylaxis in infants with pyelonephritis and normal urinary tract.
  
  
  METHODS
  Altogether 191 infants, who were diagnosed with acute pyelonephritis, proven to have normal urinary tracts and followed up for 6 months on prophylaxis, were retrospectively evaluated. According to the types of prophylaxis, the infants were divided into three groups [probiotics (Lactobacillus species), antibiotics (trimethoprim/sulfamethoxazole, TMP/SMX), and noprophylaxis]. The incidence of recurrent urinary tract infection (UTI) during 6 months after the development of pyelonephritis, main causative uropathogens, and its antimicrobial sensitivities were compared.
  
  
  RESULTS
  The incidence of recurrent UTI in the probiotic group was 8.2%, which was significantly lower than 20.6% in the no-prophylaxis group (P=0.035) and was not significantly different from 10.0% of the antibiotic group (P=0.532). The significant difference between the probiotic and no-prophylaxis groups was seen only in male infants (P=0.032). The main causative organism of recurrent UTI was Escherichia coli (E.coli), which was not different among the three groups (P=0.305). The resistance rate of E. coli to TMP/SMX was 100% in the antibiotic group, which was significantly higher than 25.0% in the probiotic group and 41.7% in the no-prophylaxis group (P=0.008).
  
  
  CONCLUSIONS
  Probiotic prophylaxis was more effective in infants with pyelonephritis and normal urinary tract than in those with no-prophylaxis. It could be used as a natural alternative to antibiotic prophylaxis.
authors.affiliation: Department of Pediatrics, Ewha Women's University School of Medicine, Seoul, Korea.
authors.forename: Seung Joo
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Ewha Women's University School of Medicine, Seoul, Korea.
authors.forename: Jihae
authors.initials: J
authors.lastname: Cha
authors.affiliation: Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea. happymaniajw@hanmail.net.
authors.forename: Jung Won
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011322:Primary Prevention / Q000379:methods; D019936:Probiotics / Q000627:therapeutic use*; D011704:Pyelonephritis / Q000188:drug therapy* / Q000517:prevention & control*; D012008:Recurrence; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic prophylaxis; antibiotic resistance; probiotic prophylaxis; pyelonephritis