Abstract
The main goal of the management of vesicoureteral reflux (VUR) is prevention of recurrent urinary tract infections (UTIs), and thereby prevention of renal parenchymal damage possibly ensuing from these infections. Long-term antibiotic prophylaxis is common practice in the management of children with VUR, as recommended in 1997 in the guidelines of the American Urological Association. We performed a systematic review to ascertain whether antibiotics can be safely discontinued in children with VUR and whether prophylaxis is effective in the prevention of recurrent UTIs and renal damage in these patients. Several uncontrolled studies indicate that antibiotic prophylaxis can be discontinued in a subset of patients, that is, school-aged children with low-grade VUR, normal voiding patterns, kidneys without hydronephrosis or scars, and normal anatomy of the urogenital system. Furthermore, a few recent randomized controlled trials suggest that antibiotic prophylaxis offers no advantage over intermittent antibiotic therapy of UTIs in terms of prevention of recurrent UTIs or new renal damage.
Highlights
Vesicoureteral reflux (VUR) is defined as the abnormal, retrograde flow of urine from the urinary bladder into the upper urinary tract
We performed a systematic review to ascertain whether antibiotics can be safely discontinued in children with vesicoureteral reflux (VUR) and whether prophylaxis is effective in the prevention of recurrent urinary tract infections (UTIs) and renal damage in these patients
Despite the lack of evidence for its effectiveness, long-term antibiotic prophylaxis has been a common practice in the management of children with VUR for decades
Summary
Vesicoureteral reflux (VUR) is defined as the abnormal, retrograde flow of urine from the urinary bladder into the upper urinary tract. VUR can be primary, caused by an anatomically insufficient vesicoureteric junction, or secondary, due to an infravesical obstruction. The prevalence rises to 10–20% in children with antenatally detected hydronephrosis, to 30% in siblings of children with known VUR, and to 30–40% in children with a proved urinary tract infection (UTI) [1, 2]. The retrograde flow of urine from the bladder into the ureter may transport bacteria to the upper urinary tract, possibly predisposing these children to febrile UTI, which can result in permanent renal parenchymal damage. Renal damage results in reflux nephropathy which could cause hypertension and decreased renal function the risk seems to be lower than previously thought [3,4,5]
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