title: Comparison of cotrimoxazole vs. second-generation cephalosporins for prevention of urinary tract infections in children.
abstract: Antimicrobial prophylaxis is recommended for the prevention of urinary tract infections (UTI) in high-risk children. However, there is growing concern about the use of β-lactams as prophylaxis and subsequent development of antibiotic resistance.
  
  
  
  In this prospective, randomized, crossover controlled trial we compared cotrimoxazole (SXT) and second-generation cephalosporins (2GC) as UTI prophylaxis in children ranging in age from 1 to 60 months. Eligible patients were 1:1 randomized to receive either SXT or 2GC for the initial 6-month period (1 course), then switched to the other antimicrobial agent class for the subsequent course, with switching continuing after each course until the end of the study. Urethral orifice cultures (UOCs) were obtained at the time of switching antimicrobial prophylaxis.
  
  
  
  Among 97 children (mean age 13.6 months) on prophylaxis, breakthrough UTIs occurred during 13.3 % (10/75) of SXT courses and 10.3 % (8/78) of 2GC courses (p = 0.62). 2GC failed earlier than SXT (mean ± standard error: 0.81 ± 0.1 vs. 2.37 ± 0.36 months, respectively; p = 0.028). Pseudomonas aeruginosa and Enterococcus spp. were more frequently isolated after 2GC courses than after SXT courses [22.6 vs. 4.8 % (p = 0.02) and 20.7 vs. 4.8 % (p = 0.035), respectively]. Prophylaxis with 2GC significantly increased resistance to both 2GC and SXT, while SXT prophylaxis did not affect susceptibility to 2GC.
  
  
  
  While SXT and 2GC appear to be equally efficacious as UTI prophylaxis in children, the latter exert a broader effect on patients' flora and development of bacterial resistance, suggesting that SXT may be more appropriate for UTI prophylaxis than 2GC.
authors.affiliation: 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University School of Medicine, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Antachopoulos
authors.affiliation: 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University School of Medicine, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Ioannidou
authors.affiliation: 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University School of Medicine, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tratselas
authors.affiliation: 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University School of Medicine, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Iosifidis
authors.affiliation: 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University School of Medicine, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.
authors.forename: Aspasia
authors.initials: A
authors.lastname: Katragkou
authors.affiliation: 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University School of Medicine, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.
authors.forename: Paschalis
authors.initials: P
authors.lastname: Kadiltzoglou
authors.affiliation: 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University School of Medicine, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kollios
authors.affiliation: 3rd Department of Pediatrics, Hippokration General Hospital, Aristotle University School of Medicine, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece. roilides@med.auth.gr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
mesh_terms: D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D002675:Child, Preschool; D018592:Cross-Over Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014552:Urinary Tract Infections / Q000517:prevention & control* / Q000652:urine
chemical_list: D000892:Anti-Infective Agents, Urinary; D002511:Cephalosporins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Antimicrobial prophylaxis; Bacterial resistance; Cephalosporins; Children; Cotrimoxazole; Urinary tract infection