PMID- 28557737
OWN - NLM
STAT- MEDLINE
DCOM- 20170810
LR  - 20170810
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Linking)
VI  - 139
IP  - 5
DP  - 2017 May
TI  - Antibiotic Prophylaxis for Urinary Tract Infection-Related Renal Scarring: A
      Systematic Review.
LID - e20163145 [pii]
LID - 10.1542/peds.2016-3145 [doi]
AB  - CONTEXT: Acute pyelonephritis may result in renal scarring. Recent prospective
      studies have shown a small benefit of antibiotic prophylaxis in preventing
      symptomatic and febrile urinary tract infections (UTIs), while being underpowered
      to detect any influence in prevention of renal damage. OBJECTIVES: Review of the 
      literature and a meta-analysis to evaluate the effect of antibiotic prophylaxis
      on UTI-related renal scarring. DATA SOURCES: Medline, Embase, and Cochrane
      Controlled Trials Register electronic databases were searched for studies
      published in any language and bibliographies of identified prospective randomized
      controlled trials (RCTs) performed and published between 1946 and August 2016.
      STUDY SELECTION: Subjects 18 years of age or younger with symptomatic or febrile 
      UTIs, enrolled in prospective RCTs of antibiotic prophylaxis where (99m)Tc
      dimercaptosuccinic acid scans were performed at entry into the study and at late 
      follow-up to detect new scar formation. DATA EXTRACTION: The literature search,
      study characteristics, inclusion and exclusion criteria, and risk of bias
      assessment were independently evaluated by 2 authors. RESULTS: Seven RCTs (1427
      subjects) were included in the meta-analysis. Our results show no influence of
      antibiotic prophylaxis in preventing renal scarring (pooled risk ratio, 0.83; 95%
      confidence interval, 0.55-1.26) as did a subanalysis restricted to those subjects
      with vesicoureteral reflux (pooled risk ratio, 0.79; 95% confidence interval,
      0.51-1.24). LIMITATIONS: Limitations include the small number of studies, short
      duration of follow-up, and insufficient children with high-grade dilating reflux 
      and/or renal dysplasia enrolled in the studies. CONCLUSIONS: Antibiotic
      prophylaxis is not indicated for the prevention of renal scarring after a first
      or second symptomatic or febrile UTI in otherwise healthy children.
CI  - Copyright (c) 2017 by the American Academy of Pediatrics.
FAU - Hewitt, Ian K
AU  - Hewitt IK
AD  - Department of Paediatric Nephrology, Princess Margaret Hospital for Children,
      Perth, Western Australia, Australia.
FAU - Pennesi, Marco
AU  - Pennesi M
AD  - Department of Pediatrics and.
FAU - Morello, William
AU  - Morello W
AD  - Pediatric Nephrology, Dialysis and Transplant Unit, Department of Clinical
      Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore
      Policlinico, University of Milan, Italy.
FAU - Ronfani, Luca
AU  - Ronfani L
AD  - Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health -
      IRCCS "Burlo Garofolo," Trieste, Italy; and.
FAU - Montini, Giovanni
AU  - Montini G
AD  - Pediatric Nephrology, Dialysis and Transplant Unit, Department of Clinical
      Sciences and Community Health, Fondazione IRCCS Ca' Granda - Ospedale Maggiore
      Policlinico, University of Milan, Italy giovanni.montini@unimi.it.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20170406
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
SB  - AIM
SB  - IM
CIN - Evid Based Med. 2017 Dec;22(6):208. PMID: 29056605
MH  - Acute Disease
MH  - *Antibiotic Prophylaxis
MH  - Child
MH  - Cicatrix/*prevention & control
MH  - Humans
MH  - Kidney/*pathology
MH  - Pyelonephritis/*drug therapy
MH  - Urinary Tract Infections/*drug therapy
COIS- POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential
      conflicts of interest to disclose.
EDAT- 2017/05/31 06:00
MHDA- 2017/08/11 06:00
CRDT- 2017/05/31 06:00
PHST- 2017/02/03 00:00 [accepted]
PHST- 2017/05/31 06:00 [entrez]
PHST- 2017/05/31 06:00 [pubmed]
PHST- 2017/08/11 06:00 [medline]
AID - peds.2016-3145 [pii]
AID - 10.1542/peds.2016-3145 [doi]
PST - ppublish
SO  - Pediatrics. 2017 May;139(5). pii: peds.2016-3145. doi: 10.1542/peds.2016-3145.
      Epub 2017 Apr 6.