Using long-term antibiotic prophylaxis to prevent urinary tract infection in pediatric patients with grade III, IV, and V vesicoureteral reflux
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on October 4th, 2023
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In children diagnosed with moderate-to-severe vesicoureteral reflux, continuous antibiotic therapy is a current practice aimed at lowering the risk of urinary tract infections, which can potentially progress to pyelonephritis and result in kidney scarring. Nevertheless, the prolonged use of antibiotics has the potential to disturb the child's microbiome and contribute to the emergence of multidrug-resistant bacteria. As a result, a study was conducted to assess the advantages and potential risks associated with antibiotic prophylaxis in children diagnosed with grade III, IV, and V vesicoureteral reflux.
The phase 3 randomized controlled trial, sponsored by the Italian Ministry of Health, included 292 children with an average age of 3 months. Among them, 80.5% had grade IV and V vesicoureteral reflux. These children were randomly allocated to either receive a placebo or undergo continuous antibiotic prophylaxis for a duration of 2 years. The choice of antibiotic was based on the physician's discretion, taking into account local E. coli resistance patterns. The potential antimicrobial agents included nitrofurantoin, amoxicillin-clavulanate, cefixime, and trimethoprim-sulfamethoxazole. After 24 months of treatment, the researchers determined that continuous antibiotic prophylaxis reduced the risk of urinary tract infection by 45%. Additionally, the study examined the development of antimicrobial resistance, and preliminary findings indicated a higher rate of antibiotic resistance in the antibiotic prophylaxis group.
The phase 3 randomized controlled trial, sponsored by the Italian Ministry of Health, included 292 children with an average age of 3 months. Among them, 80.5% had grade IV and V vesicoureteral reflux. These children were randomly allocated to either receive a placebo or undergo continuous antibiotic prophylaxis for a duration of 2 years. The choice of antibiotic was based on the physician's discretion, taking into account local E. coli resistance patterns. The potential antimicrobial agents included nitrofurantoin, amoxicillin-clavulanate, cefixime, and trimethoprim-sulfamethoxazole. After 24 months of treatment, the researchers determined that continuous antibiotic prophylaxis reduced the risk of urinary tract infection by 45%. Additionally, the study examined the development of antimicrobial resistance, and preliminary findings indicated a higher rate of antibiotic resistance in the antibiotic prophylaxis group.