Abstract
Antibiotic prophylaxis is prescribed to prevent recurrent urinary tract infections (UTIs) in children, but this practice is being questioned with attention to efficacy and potential harm of long-term antibiotics. Prophylaxis for children with vesicoureteral reflux remains controversial and providers should consider factors that contribute to risk of recurrent UTI such as age, sex, circumcision status, reflux grade, and bladder and bowel dysfunction. Further complicating our understanding of the impact of prophylaxis is evidence that adherence is poor. Antibiotic resistance is a growing problem that is exacerbated by prophylaxis. Some children have a reduced rate of recurrent UTIs when treated with prophylaxis, though which subset of those at risk who will benefit remains unclear. Given this uncertainty, current guidelines allow physicians to individualize care. Reduction of recurrent UTIs must be balanced with the harm of prophylaxis, including the development of antibiotic resistance.
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