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Comparison of cotrimoxazole vs. second-generation cephalosporins for prevention of urinary tract infections in children



Antimicrobial prophylaxis is recommended for the prevention of urinary tract infections (UTI) in high-risk children. However, there is growing concern about the use of β-lactams as prophylaxis and subsequent development of antibiotic resistance.


In this prospective, randomized, crossover controlled trial we compared cotrimoxazole (SXT) and second-generation cephalosporins (2GC) as UTI prophylaxis in children ranging in age from 1 to 60 months. Eligible patients were 1:1 randomized to receive either SXT or 2GC for the initial 6-month period (1 course), then switched to the other antimicrobial agent class for the subsequent course, with switching continuing after each course until the end of the study. Urethral orifice cultures (UOCs) were obtained at the time of switching antimicrobial prophylaxis.


Among 97 children (mean age 13.6 months) on prophylaxis, breakthrough UTIs occurred during 13.3 % (10/75) of SXT courses and 10.3 % (8/78) of 2GC courses (p = 0.62). 2GC failed earlier than SXT (mean ± standard error: 0.81 ± 0.1 vs. 2.37 ± 0.36 months, respectively; p = 0.028). Pseudomonas aeruginosa and Enterococcus spp. were more frequently isolated after 2GC courses than after SXT courses [22.6 vs. 4.8 % (p = 0.02) and 20.7 vs. 4.8 % (p = 0.035), respectively]. Prophylaxis with 2GC significantly increased resistance to both 2GC and SXT, while SXT prophylaxis did not affect susceptibility to 2GC.


While SXT and 2GC appear to be equally efficacious as UTI prophylaxis in children, the latter exert a broader effect on patients’ flora and development of bacterial resistance, suggesting that SXT may be more appropriate for UTI prophylaxis than 2GC.

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The investigators wish to thank their colleagues from the Third Department of Pediatrics, Aristotle University of Thessaloniki, for referring potentially eligible patients for this study. They also wish to thank all children and their parents who participated in the study.

Contribution of each co-author

C. Antachopoulos conducted the study and wrote the first draft of the manuscript. M. Ioannidou conducted the study and reviewed the manuscript. A. Tratselas conducted the study and reviewed the manuscript. E. Iosifidis analyzed data and reviewed the manuscript. A. Katragkou conducted the study and reviewed the manuscript. P. Kadiltzoglou conducted the study and reviewed the manuscript. K. Kollios conducted the study and reviewed the manuscript. E. Roilides designed the protocol and reviewed the manuscript

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Correspondence to Emmanuel Roilides.

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This study was not funded by any source.

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All of the authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Antachopoulos, C., Ioannidou, M., Tratselas, A. et al. Comparison of cotrimoxazole vs. second-generation cephalosporins for prevention of urinary tract infections in children. Pediatr Nephrol 31, 2271–2276 (2016).

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  • Urinary tract infection
  • Children
  • Antimicrobial prophylaxis
  • Bacterial resistance
  • Cephalosporins
  • Cotrimoxazole