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Non-antibiotic interventions for prevention of urinary tract infections in children: a systematic review and meta-analysis of randomized controlled trials

Abstract

A considerable proportion of children experience a recurrence of urinary tract infection (UTI) following the first episode. While low-dose antibiotic prophylaxis has been the mainstay for the prevention of UTI, recent evidence raised concerns over their efficacy and safety. Hence, we aim to systematically synthesize evidence on the efficacy and safety of non-antibiotic prophylactic interventions for UTI. Using keywords related to study population (children) and intervention (non-antibiotic), we searched CENTRAL, Embase, PubMed, and Web of Science for randomized controlled trials (RCTs) published until August 2020. RCTs comparing any non-antibiotic interventions with placebo/antibiotics for prevention of UTIs in children were considered eligible. We used a random-effect model to provide pooled estimates. Sixteen trials evaluating 1426 participants were included. Cranberry was as effective as antibiotic prophylaxis (RR: 0.92; 95% CI: 0.56–1.50) but better than placebo/no therapy (RR: 0.48; 95% CI: 0.28–0.80) in reducing UTI recurrence. Probiotic therapy was more effective in reducing UTI recurrence (RR: 0.52; 95% CI: 0.29–0.94) when compared with placebo. While probiotic therapy was not better than antibiotics prophylaxis in preventing UTI (RR: 0.82; 95% CI: 0.56–1.21), they have a lower risk of antibiotic resistance (RR: 0.38; 95% CI: 0.21–0.69).

Conclusion: Cranberry products and probiotics are the two non-antibiotic interventions that have been chiefly evaluated, reduce the risk of UTI recurrence when compared with placebo in children with a normal urinary tract. The findings from this systematic review suggest that while cranberry and probiotics may be used, there is a definite need to identify better and more acceptable non-antibiotic interventions.

What is Known:
Efficacy of the low-dose antibiotic is controversial in preventing UTI and it is associated with increase in the risk of antimicrobial resistance.
Non-antibiotic interventions such as cranberry products are effective in preventing UTI recurrence in adults.
What is New:
Cranberry products are effective in reducing the recurrence of UTI in children with normal urinary tract.
Low-quality evidence suggests that probiotics can be a potential prophylactic measure to reduce recurrence of UTI in the pediatric population.

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Abbreviations

CI:

Confidence interval

GRADE:

Grading of Recommendations Assessment, Development, and Evaluation

RR:

Risk ratio

UTI:

Urinary tract infection

VUR:

Vesicoureteral reflux

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Concept and design: JM, PH; acquisition, analysis, or interpretation of data: JM, CCT, JK, SR; drafting of the manuscript: JM, SR, CCT; critical revision of the manuscript for important intellectual content: JM, JK, PH. All authors read and approved the final manuscript.

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Correspondence to Pankaj Hari.

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Not applicable. Protocol for this systematic review was registered with PROSPERO [CRD42020208967].

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Communicated by Gregorio Paolo Milani

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Meena, J., Thomas, C.C., Kumar, J. et al. Non-antibiotic interventions for prevention of urinary tract infections in children: a systematic review and meta-analysis of randomized controlled trials. Eur J Pediatr (2021). https://doi.org/10.1007/s00431-021-04091-2

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Keywords

  • Cranberry
  • Pediatrics
  • Probiotics, Prophylaxis
  • Urinary tract infection