Classics in pediatric hospital medicine.

Abstract

We have decided to take a new look at 3 classics in hospital medicine. The first addresses the subject matter voted most likely to induce a Hospitalist versus Urologist thumb-wrestling match: antibiotic prophylaxis in urinary tract infection (UTI) with vesicoureteral reflux (VUR). Antibiotic prophylaxis has been prescribed for VUR for some time, and recent literature has sparked the debate .1 So, we thought this randomized double-blind placebo-controlled trial was worth investigating. ### The study. This was a randomized double-blind placebo-controlled trial to examine the effect of antibiotic prophylaxis after UTI on recurrence and renal scarring in patients with VUR over 12 months. The primary outcome was number of UTIs. Secondary outcomes included asymptomatic bacteriuria, UTI with resistant bacteria, antibiotic administration for concomitant infections, and worsening of scarring. ### The key findings. The authors randomized 93 children (66.7% boys) aged 1 to 12 years with febrile UTI and VUR grades I to IV (73% grades III–IV). Ten of the 47 in the antibiotic group and 3 of 46 patients in the placebo group developed symptomatic UTIs (absolute risk increase of 14.8% [–28.0 to –1.0], P = .03). There was no difference in any other outcomes, including scarring. The trial was stopped early. #### Why do we care? A large trial designed to definitively answer the question of prophylaxis unfortunately raised more questions than it answered.2 The trial by Hari et …