CHICAGO The use of prophylactic antibiotics, which involves daily administration of antibiotics to children after an initial urinary tract infection, is not associated with reduced risk of recurrent urinary tract infections, but is associated with an increased risk of resistant infections, according to a study in the July 11 issue of JAMA.
Estimates of cumulative incidence of UTI in children younger than 6 years (3 percent - 7 percent in girls, 1 percent to 2 percent in boys) suggest that 70,000 to 180,000 of the annual
Patrick H. Conway, MD, MSc, of the
Among 74,974 children in the network, 611 had a first UTI and 83 had a recurrent UTI. The researchers found that factors associated with increased risk of recurrent UTI were white race (nearly twice the risk), age 3 to 4 years (2.75 times the risk), age 4 to 5 years (2.5 times the risk), and grade 4 to 5 VUR (4.4 times the risk). Severity of VUR is measured by a grade of 1-5, with 5 being the most severe. Sex, grade 1 to 3 VUR, and other antibiotic exposure had no effect on risk of recurrent UTI. Exposure to prophylactic antibiotics significantly increased the likelihood of resistant infections (7.5 times increased risk).
Given previous findings and the unfavorable risk/benefit ratio demonstrated by the current study, we think it is prudent for clinicians to discuss the risks and unclear benefits of prophylaxis with families as they make family-centered decisions about whether to start prophylactic [antibiotics] or to closely monitor a child without prescribing [antibiotic] prophylaxis after a first UTI, the authors write.
Reference: JAMA. 2007;298(2):179-186.
Source: American Medical Association