Format

Send to

Choose Destination
J Urol. 2015 Mar;193(3):963-9. doi: 10.1016/j.juro.2014.08.112. Epub 2014 Sep 6.

Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: systematic review and meta-analysis.

Author information

1
Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
2
Division of Pediatric Nephrology, Duke University Medical Center, Durham, North Carolina.
3
Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: Jonathan.Routh@duke.edu.

Abstract

PURPOSE:

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.

MATERIALS AND 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.

KEYWORDS:

antibiotic prophylaxis; meta-analysis; pediatrics; review; vesico-ureteral reflux

Comment in

PMID:
25196653
PMCID:
PMC4380260
DOI:
10.1016/j.juro.2014.08.112
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wolters Kluwer Icon for PubMed Central
Loading ...
Support Center