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Review: antibiotic prophylaxis may not prevent recurrent symptomatic urinary tract infection in children

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Question

In children [patients] with and without vesicoureteric reflux (VUR), do long-term antibiotics [intervention] prevent urinary tract infection (UTI) [outcome]?

Review scope

Trials were selected which compared long-term (at least 2 months) antibiotic prophylaxis versus placebo or no treatment, in children <18 years old. The primary outcome was recurrence of symptomatic UTI. Other outcomes were repeat positive urinary culture, renal scarring and adverse events.

Review methods

MEDLINE, Embase, CENTRAL, the Cochrane Library and reference lists were searched for randomised controlled trials (RCTs) and quasi-RCTs. No language restriction was applied. The quality of studies, assessed by two reviewers, was based on allocation concealment, standardisation and blinding of outcome assessment, intention to treat analysis and losses to follow-up. Eleven RCTs were included.

Main results

The 11 trials included a total of 2046 children. All but one trial included children with VUR. The quality of trials varied (only three described the allocation concealment process, only two were double-blinded, only four had intention to treat analysis). The treatment regimen was usually co-trimoxazole or nitrofurantoin. The duration of prophylaxis and …

Correspondence to Department of Evidence-Based Medicine, Sinaloa's Pediatric Hospital, Sinaloa, Mexico; giordanoperez{at}hps.org.mx

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