Pediatric Nephrology

, Volume 21, Issue 1, pp 5–13 | Cite as

May we go on with antibacterial prophylaxis for urinary tract infections?

Editorial Commentary

Abstract

Recurrent urinary tract infections (UTIs), with or without vesicoureteric reflux (VUR), are by far the most frequent reason for long-term antibacterial prophylaxis in infants and children today. However, the strategies of antibacterial prophylaxis for the prevention of recurrent urinary tract infection are no longer universally accepted. In infants and children at risk, the benefits of antibacterial prophylaxis definitively are not yet proven by evident data. To put antibacterial prophylaxis in its place, risk groups for recurrent symptomatic infections, ascending UTI and permanent renal damage have to be defined and the efficacy of prophylaxis in these groups has to be proved by prospective randomised studies. Nevertheless, until the results of these studies are available, antibacterial prophylaxis will remain one of the most frequently practised methods to protect risk patients from pyelonephritic damage and UTI recurrences.

Keywords

Antibacterial prophylaxis Pyelonephritis Renal damage Urinary tract infections Vesicoureteric reflux 

References

  1. 1.
    Smith J, Finn A (1999) Antimicrobial prophylaxis. Arch Dis Child 80:388–392PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Helmholtz HF (1941) Mayo Clin Proc 16:145Google Scholar
  3. 3.
    Marshall M Jr, Johnson SH (1956) An initial report of the treatment of chronic urinary tract infection in children with nitrofurantoin. J Urol 76:123–128PubMedGoogle Scholar
  4. 4.
    Stansfield JM, Webb JGG (1954) A plea for the longer treatment of chronic pyelonephritis in children. BMJ 1:616–618CrossRefGoogle Scholar
  5. 5.
    Smellie JM, Hodson CJ, Edwards D, Normand ICS (1964) Clinical and radiological features of urinary tract infection in childhood. Br Med J 2:1222–1226PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Smellie JM, Grüneberg RN, Leakey A, Atkin WS (1976) Long-term low-dose co-trimoxazole in prophylaxis of childhood urinary tract infection: clinical aspects. Br Med J 2:203–206PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Smellie JM, Katz G, Grueneberg RN (1978) Controlled trial of prophylactic treatment in childhood urinary tract infection. Lancet ii:175–178CrossRefGoogle Scholar
  8. 8.
    Lohr JA, Nunley DH, Howards SS, Ford RF (1977) Prevention of recurrent urinary tract infections in girls. Pediatrics 59:562–565PubMedGoogle Scholar
  9. 9.
    Smellie JM, Grüneberg RN, Normand ICS, Bantock HM (1982) Trimethoprim-sulfamethoxazole and trimethoprim alone in the prophylaxis of childhood urinary tract infection. Rev Infect Dis 4:461–466PubMedCrossRefGoogle Scholar
  10. 10.
    Williams G, Lee A, Craig JC (2001) Antibiotics for the prevention of urinary tract infection in children: a systematic review of randomised controlled trials. J Pediatr 138:868–874PubMedCrossRefGoogle Scholar
  11. 11.
    Jodal U, Winberg J (1987) Management of children with unobstructed urinary tract infection. Pediatr Nephrol 1:647–656PubMedCrossRefGoogle Scholar
  12. 12.
    Elder JS, Peters CA, Arant BS, Ewalt DH, Hawtrey CE, Hurwitz RS, Parrott TS, Snyder HM, Weis RA, Woolf SH, Hasselblad V (1997) Pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children. J Urol 157:1846–1851PubMedCrossRefGoogle Scholar
  13. 13.
    Lindert KA, Shortliffe LMD (1999) Evaluation and management of pediatric urinary tract infections. Urol Clin North Am 26:719–728PubMedCrossRefGoogle Scholar
  14. 14.
    Rushton HG (1997) Urinary tract infections in children. Pediatr Clin North Am 44:1133–1169PubMedCrossRefGoogle Scholar
  15. 15.
    Fine RN (1992) Diagnosis and treatment of fetal urinary tract abnormalities. J Pediatr 121:333–341PubMedCrossRefGoogle Scholar
  16. 16.
    Winberg J, Bollgren I, Källenius G, Möllby R, Svenson SB (1982) Clinical pyelonephritis and focal renal scarring. A selected review of pathogenesis, prevention, and prognosis. Pediatr Clin North Am 29:801–814PubMedGoogle Scholar
  17. 17.
    Winberg J, Bergstrom T, Jacobsson B (1975) Mortality, age and sex distribution, recurrences and renal scarring in symptomatic urinary tract infection in childhood. Kidney Int [Suppl] S101–S106Google Scholar
  18. 18.
    Nuutinen M, Uhari M (2001) Recurrence and follow-up after urinary tract infection under the age of 1 year. Pediatr Nephrol 16:69–72PubMedCrossRefGoogle Scholar
  19. 19.
    McCracken GH (1984) Recurrent urinary tract infections in children. Pediatr Infect Dis 3:28–30CrossRefGoogle Scholar
  20. 20.
    Kasanen A, Sundquist H, Elo J, Anttila M, Kangas L (1983) Secondary prevention of urinary tract infections. Ann Clin Res 15 [Suppl 36]: 5–36Google Scholar
  21. 21.
    Kunin CM (1987) Detection, prevention and management of urinary tract infections. Lea & Febiger, PhiladelphiaGoogle Scholar
  22. 22.
    Mannhardt W, Becker A, Putzer M, Bork M, Zepp F, Hacker J, Schulte-Wissermann H (1996) Host defense within the urinary tract. I. Bacterial adhesion initiates an uroepithelial defense mechanism. Pediatr Nephrol 10:568–572PubMedCrossRefGoogle Scholar
  23. 23.
    Hellerstein S, Nickell E (2002) Prophylactic antibiotics in children at risk for urinary tract infection. Pediatr Nephrol 17:506–510PubMedCrossRefGoogle Scholar
  24. 24.
    Smellie JM, Grüneberg RN, Bantock HM, Prescod N (1988) Prophylactic co-trimoxazole and trimethoprim in the management of urinary tract infection in children. Pediatr Nephrol 2:12–17PubMedCrossRefGoogle Scholar
  25. 25.
    Jakobsson B, Nolstedt L, Svensson L, Söderlundh S, Berg U (1992) 99mTc-dimercaptosuccinic acid (DMSA) scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings. Pediatr Nephrol 6:328–334PubMedCrossRefGoogle Scholar
  26. 26.
    Rushton HG, Majd M, Jantausch B, Wiedermann BL, Belman AB (1992) Renal scarring following reflux and nonreflux pyelonephritis in children: evaluation with 99mtechnetium-dimercaptosuccinic acid scintigraphy. J Urol 147:1327–1332PubMedGoogle Scholar
  27. 27.
    Jodal U (1987) The natural history of bacteriuria in childhood. Infect Dis Clin North Am 1:713–729PubMedGoogle Scholar
  28. 28.
    Berg UB (1989) Renal dysfunction in recurrent urinary tract infections in childhood. Pediatr Nephrol 3:9–15PubMedCrossRefGoogle Scholar
  29. 29.
    Smellie JM, Ransley PG, Normand ICS, Prescod N, Edwards D (1985) Development of new renal scars: a collaborative study. BMJ 290:1957–1960PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Benador D, Benador N, Slozman D, Memillod B, Girardin E (1997) Are younger patients at higher risk of renal sequela after pyelonephritis? Lancet 349:17–19PubMedCrossRefGoogle Scholar
  31. 31.
    Ransley PG, Risdon RA (1978) Reflux and renal scarring. Br J Radiol [Suppl] 14:1–35Google Scholar
  32. 32.
    Linshaw MA (1999) Controversies in childhood urinary tract infections. World J Urol 17:383–395PubMedCrossRefGoogle Scholar
  33. 33.
    Garin EH, Campos A, Homsy Y (1998) Primary vesicoureteral reflux: review of current concepts. Pediatr Nephrol 12:249–256PubMedCrossRefGoogle Scholar
  34. 34.
    Wennerström M, Hansson S, Jodal U, Stokland E (2000) Primary and acquired renal scarring in boys and girls with urinary tract infection. J Pediatr 136:30–34CrossRefGoogle Scholar
  35. 35.
    Rushton HG (1997) The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions. Pediatr Nephrol 11:108PubMedCrossRefGoogle Scholar
  36. 36.
    Wheeler D, Vimalachandra D, Hodson EM, Roy KLP, Smith G, Craig JC (2003) Antibiotics and surgery for VUR: a meta-analysis of randomised controlled trials. Arch Dis Child 88:688–694PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Larcombe J (1999) Clinical evidence: Urinary tract infection in children. BMJ 319:1173–1175PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Le Saux N, Pham Ba’, Moher D (2000) Evaluating the benefits of antimicrobial prophylaxis to prevent urinary tract infections in children: a systematic review. CMAJ 163:523–529Google Scholar
  39. 39.
    Jodal U (1994) Aspects of clinical trials of drug efficacy in children with uncomplicated infections. Infection 22: S10–S11PubMedCrossRefGoogle Scholar
  40. 40.
    Reddy PP, Evans MT, Hughes PA, Dangman B, Cooper J, Lepow ML, Calvano CJ, Mandell J, (1997) Antimicrobial prophylaxis in children with vesico-ureteral reflux: a randomized prospective study of continuous therapy vs intermittent therapy vs surveillance Pediatrics 100 [Suppl]:555Google Scholar
  41. 41.
    Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon MJ, Barratt TM (1990) The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 144:584–587PubMedGoogle Scholar
  42. 42.
    Madden NP, Thomas DF, Gordon AC, Arthur RJ, Irving HC, Smith SE (1993) Antenatally detected pelviureteric junction obstruction. Is non-operation safe? Br J Urol 68:305–310CrossRefGoogle Scholar
  43. 43.
    Galloway A (1997) Prevention of urinary tract infection in patients with spinal cord injury—a microbiological review. Spinal Cord 35:198–204PubMedCrossRefGoogle Scholar
  44. 44.
    Biering-Sorensen F, Hoiby N, Nordenbo A, Ravnborg M, Bruun B, Rahm V (1994) Ciprofloxacin as prophylaxis for urinary tract infection: prospective, randomised, cross-over, placebo-controlled study in patients with spinal cord lesion. J Urol 151:105–108PubMedGoogle Scholar
  45. 45.
    Johnson HW, Anderson JD, Chambers GK, Arnold WJD, Irwin BJ, Brinton JR (1994) A short-term study of nitrofurantoin prophylaxis in children managed with clean intermittent catheterization. Pediatrics 93:752–755PubMedGoogle Scholar
  46. 46.
    Kuhlemeier KV, Stover SL, Loyd LK (1985) Prophylactic antibacterial therapy for preventing urinary tract infections in spinal cord injury patients. J Urol 134:514–517PubMedGoogle Scholar
  47. 47.
    Mohler JL, Cowen DL, Flanigan RC (1987) Suppression and treatment of urinary tract infection in patients with an intermittently catheterized neurogenic bladder. J Urol 138:336–340PubMedGoogle Scholar
  48. 48.
    Morton SC, Shekelle PG, Adams JL, Bennett C, Dobkin BH, Montgomerie J, Vickrey BG (2002) Antimicrobial prophylaxis for urinary tract infection in persons with spinal cord dysfunction. Arch Phys Med Rehabil 83:129–138PubMedCrossRefGoogle Scholar
  49. 49.
    Nicolle LE (1992) Prophylaxis: recurrent urinary tract infection in women. Infection 20: S203–S205PubMedCrossRefGoogle Scholar
  50. 50.
    Gupta K, Stamm WE (1999) Pathogenesis and management of recurrent urinary tract infections in women. World J Urol 17:415–420PubMedCrossRefGoogle Scholar
  51. 51.
    Nicolle LE, Ronald AR (1998) Recurrent urinary tract infection and its prevention. In: Brumfitt W, Hamilton-Miller JMT, Bailey RR (eds) Urinary tract infections. Chapman and Hall, Cambridge, UK, pp 293–301Google Scholar
  52. 52.
    Stapleton A, Stamm WE (1997) Prevention of urinary tract infection. Infect Dis Clin North Am 11:719–734PubMedCrossRefGoogle Scholar
  53. 53.
    Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE (1992) Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis 15 [Suppl 1]:S216–S227Google Scholar
  54. 54.
    Albert X, Huertas I, Pereiro I, Sanfelix J, Gosalbes V, Perrota C (2004) Antibiotics for preventing recurrent urinary tract infection in non-pregnant women (Cochrane Review). In: The Cochrane Library, Issue 3. Wiley, Chichester, UKGoogle Scholar
  55. 55.
    Brumfitt W, Hamilton-Miller JMT (1998) Efficacy and safety profile of long-term nitrofurantoin in urinary infections: 18 years’ experience. J Antimicrob Chemother 42:363–371PubMedCrossRefGoogle Scholar
  56. 56.
    Miller T, Phillips S (1981) Pyelonephritis: the relationship between infection, renal scarring, and antimicrobial therapy. Kidney Int 19:654–662PubMedCrossRefGoogle Scholar
  57. 57.
    Winberg J (1994) Management of primary VUR in children—operation ineffective in preventing progressive renal damage. Infection 22 [Suppl 1]:4–7Google Scholar
  58. 58.
    Hoberman A, Charran M, Hickey R, Baskin M, Kearney DH, Wald ER (2003) Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 348:251CrossRefGoogle Scholar
  59. 59.
    Smellie J, Edwards D, Hunter N, Normand ICS, Prescod N (1975) VUR and renal scarring. Kidney Int 8:65–72CrossRefGoogle Scholar
  60. 60.
    Merrick MV, Notghi A, Chalmers N, Wilkinson AG, Uttley WS (1995) Long-term follow-up to determine the prognostic value of imaging after urinary tract infections. Part 2: Scarring. Arch Dis Child 72:393–396PubMedCentralPubMedCrossRefGoogle Scholar
  61. 61.
    Brendstrup L, Hjelt K, Petersen KE, Petersen S, Andersen EA, Daugbjerg PS, Stagegaard BR, Nielsen OH, Vejlsgaard R, Schou G (1990) Nitrofurantoin versus trimethoprim prophylaxis in recurrent urinary tract infection in children. Acta Paediatr Scand 79:1225–1234PubMedCrossRefGoogle Scholar
  62. 62.
    Holmberg L, Bowman G, Bottiger LE et al (1980) Adverse reactions to nitrofurantoin: analysis of 921 reports. Am J Med 69:733–738PubMedCrossRefGoogle Scholar
  63. 63.
    Coraggio MJ, Gross TP, Roscelli JD (1989) Nitrofurantoin toxicity in children. Pediatr Infect Dis J 8:163–165PubMedGoogle Scholar
  64. 64.
    Brumfitt W, Hamilton-Miller JMT (1995) A comparative trial of low-dose cefaclor and macrocrystalline nitrofurantoin in the prevention of recurrent urinary tract infection. Infection 23:99–102CrossRefGoogle Scholar
  65. 65.
    Thompson RH, Chen JJ, Pugach J, Naseer S, Steinhardt GF (2001) Cessation of prophylactic antibiotics for managing persistent vesicoureteral reflux. J Urol 168:1465CrossRefGoogle Scholar
  66. 66.
    Coulthard MG (2002) Do kidneys outgrow the risk of reflux nephropathy? Pediatr Nephrol 17:477–480PubMedCrossRefGoogle Scholar
  67. 67.
    Coulthard MG, Flecknell P, Orr H, Manas D, O’Donnell M (2002) Renal scarring caused by VUR and urinary infection: a study in pigs. Pediatr Nephrol 17:481–484PubMedCrossRefGoogle Scholar
  68. 68.
    Craig J (1999) Quality research meets urinary tract infection. J Pediatr 135:664–666PubMedCrossRefGoogle Scholar
  69. 69.
    Norrby SR (1992) Design of clinical trials in patients with urinary tract infections. Infection 20 [Suppl 3]: S181–S188Google Scholar
  70. 70.
    Bollgren I (1999) Antibacterial prophylaxis in children with urinary tract infection. Acta Paediatr Suppl 431:48–52CrossRefGoogle Scholar
  71. 71.
    Kaneko K, Ohtomo Y, Shimizu T, Yamashiro Y, Yamataka A, Miyano T (2003) Antibiotic prophylaxis by low-dose cefaclor in children with vesicoureteral reflux. Pediatr nephrol 18:468–470PubMedGoogle Scholar
  72. 72.
    Daschner F, Marget W (1975) Treatment of recurrent urinary tract infection in children. II. Compliance of parents and children with antibiotic therapy regimes. Acta Paediatr Scand 64:105–108PubMedCrossRefGoogle Scholar
  73. 73.
    Westenfelder M, Vahlensieck W, Reinartz U (1987) Patient compliance and efficacy of low-dose long-term prophylaxis in patients with recurrent urinary tract infection. Chemioterapia [Suppl 2]:530–532Google Scholar
  74. 74.
    Montini G, Rigon L, Gobber D, Zuchetta P, Murer L et al on behalf of the IRIS (Italian Renal Infection Study) group (2004) A randomised controlled trial of antibiotic prophylaxis in children with a previous documented pyelonephritis. Pediatr Nephrol 19:C71CrossRefGoogle Scholar
  75. 75.
    Blumberg EA, Abruyn E (1997) Methods for the reduction of urinary tract infection. Curr Opin Urol 7:47–51CrossRefGoogle Scholar
  76. 76.
    Mangiarotti P, Pizzini C, Fanos V (2000) Antibiotic prophylaxis in children with relapsing urinary tract infections: review. J Chemother 12:115–123PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2005

Authors and Affiliations

  1. 1.Department of PaediatricsUniversity Clinics of MainzMainzGermany

Personalised recommendations