PEDIATRICS Vol. 93 No. 5 May 1994, pp. 752-755
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A Short-Term Study of Nitrofurantoin Prophylaxis in Children Managed With Clean Intermittent Catheterization

Hjalman W. Johnson MD, FRCSC1, John D. Anderson MD, PhD, FRCPC2, G. Keith Chambers MD, MHSc3, William J.D. Arnold MD, FRCPC4, Beverly J. Irwin BSN, RN5, and Jocelyne R. Brinton RN5

1 Department of Surgery, The University of British Columbia
2 Department of Pathology, The University of British Columbia
3 Department of Health Care and Epidemiology, The University of British Columbia
4 Department of Pediatrics, The University of British Columbia
5 Meningomyelocele Clinic, British Columbia's Children's Hospital, Vancouver, BC, V6H 3V4, Canada

Objective. Because there is no evidence for the effectiveness of antibiotic prophylaxis in children with neurogenic bladder, the value of once-daily nitrofurantoin macrocrystals was assessed in a selected population with neurogenic bladder due to meningomyelocele.

Methods and trial population. Children with significant urinary tract abnormalities other than neurogenic bladder were excluded. A urinary tract "infection" was defined as ge108 colony forming units of bacteria/L of urine together with pyuria of ge50 x 106 leukocytes/L, and/or symptoms consistent with an urinary tract infection. Fifty-six children participated in a 24-week double-blinded, placebo-controlled cross-over study. The infeclion status was assessed at two weekly intervals or if relevant clinical manifestations occurred.

Results. For the whole trial the average percentage of "infections" per urine sample for each patient was reduced from 39% on placebo to 19% on single daily dose prophylaxis (P < .0003). For the first 12 weeks of the trial corresponding figures were 45% on placebo and 22% on prophylaxis (P < .0018). There was evidence for a marked carryover protective effect of nitrofurantoin into the placebo arm of the trial.

Conclusion. Nitrofurantoin is an effective prophylactic agent during a 3-month period. Long-term studies are needed to confirm the reasonable expectation of a beneficial effect on urinary tract damage.

Submitted on June 2, 1993
Accepted on October 25, 1993




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N. L. Saux, B. Pham, and D. Moher
Evaluating the benefits of antimicrobial prophylaxis to prevent urinary tract infections in children: a systematic review
Can. Med. Assoc. J., September 1, 2000; 163(5): 523 - 529.
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