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Published online May 19, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. e1489-e1494 (doi:10.1542/peds.2007-2652)
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ARTICLE

Is Antibiotic Prophylaxis in Children With Vesicoureteral Reflux Effective in Preventing Pyelonephritis and Renal Scars? A Randomized, Controlled Trial

Marco Pennesi, MDa, Laura Travan, MD, PhDa, Leopoldo Peratoner, MDb, Andrea Bordugo, MDb, Adriano Cattaneo, MDc, Luca Ronfani, MD, PhDd, Silvia Minisini, MDa, Alessandro Ventura, MDa for the North East Italy Prophylaxis in VUR study group

a Department of Pediatrics, Institute of Child Health IRCCS Burlo Garofolo, Trieste, Italy
c Unit of Epidemiology and Biostatistics, Institute of Child Health IRCCS Burlo Garofolo, Trieste, Italy
d Unit for Health Services Research and International Health, Institute of Child Health IRCCS Burlo Garofolo, Trieste, Italy
b Department of Pediatrics, "S. Maria degli Angeli" Hospital, Pordenone, Italy

OBJECTIVES. There has been intense discussion on the effectiveness of continuous antibiotic prophylaxis for children with vesicoureteral reflux, and randomized, controlled trials are still needed to determine the effectiveness of long-term antibiotics for the prevention of acute pyelonephritis. In this multicenter, open-label, randomized, controlled trial, we tested the effectiveness of antibiotic prophylaxis in preventing recurrence of pyelonephritis and avoiding new scars in a sample of children who were younger than 30 months and vesicoureteral reflux.

METHODS. One hundred patients with vesicoureteral reflux (grade II, III, or IV) diagnosed with cystourethrography after a first episode of acute pyelonephritis were randomly assigned to receive antibiotic prophylaxis with sulfamethoxazole/trimethoprim or not for 2 years. The main outcome of the study was the recurrence of pyelonephritis during a follow-up period of 4 years. During follow-up, the patients were evaluated through repeated cystourethrographies, renal ultrasounds, and dimercaptosuccinic acid scans.

RESULTS. The baseline characteristics in the 2 study groups were similar. There were no differences in the risk for having at least 1 pyelonephritis episode between the intervention and control groups. At the end of follow-up, the presence of renal scars was the same in children with and without antibiotic prophylaxis.

CONCLUSIONS. Continuous antibiotic prophylaxis was ineffective in reducing the rate of pyelonephritis recurrence and the incidence of renal damage in children who were younger than 30 months and had vesicoureteral reflux grades II through IV.

Key Words: vesicoureteral reflux • antibiotic prophylaxis • pyelonephritis • renal scars

Abbreviations: VUR—vesicoureteral reflux • RCT—randomized, controlled trial • UTI—urinary tract infection • DMSA—dimercaptosuccinic acid • RR—relative risk • CI—confidence interval

Accepted Nov 30, 2007.


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