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ARTICLES: Marco Pennesi, Laura Travan, Leopoldo Peratoner, Andrea Bordugo, Adriano Cattaneo, Luca Ronfani, Silvia Minisini, Alessandro Ventura for the North East Italy Prophylaxis in VUR study group Is Antibiotic Prophylaxis in Children With Vesicoureteral Reflux Effective in Preventing Pyelonephritis and Renal Scars? A Randomized, Controlled Trial Pediatrics 2008; 121: e1489-e1494 [Abstract] [Full text] [PDF]

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Efficay of Antibiotic Prophylaxis in Children With VUR in Preventing Pyelonephritis

Hadi M Hussain, Zahoor Iqbal Mirza,Department Of urology,combined military hospital,lahore   (13 June 2008)

Efficay of Antibiotic Prophylaxis in Children With VUR in Preventing Pyelonephritis 13 June 2008
Hadi M Hussain, Department Of Paediatrics Combined military Hospital,Lahore, Zahoor Iqbal Mirza,Department Of urology,combined military hospital,lahore Send letter to journal: Re: Efficay of Antibiotic Prophylaxis in Children With VUR in Preventing Pyelonephritis hadimeeran{at}yahoo.com Hadi M Hussain, et al.	This is yet another article that challenges the dogma that antibiotic prophylaxis is necessary when a child is diagnosed with vesicoureteral reflux.(1) This study raises several issues that are now surrounding physicians that treat children with vesicoureteral reflux. The main issue is that for four decades physicians felt that we knew the proper treatment plan for these children. In the last five years, this dogma has been not only challenged but also refuted by several studies including this one.(2,3,4,5) So, currently we are left with incomplete information on the best form of treatment for our patients. As treating physicians, we can make the choice to continue to treat with antibiotics with the downside that some children may have a rare side effect or we can take a chance that antibiotics are not necessary. It is not clear how many and what type of clinical trials will be necessary to change the way we practice -- are 50 patients enough to change 40 years of standard practice? At this point, we have to say, for us, this is not enough information. In our opinion,this current study does not have enough statistical power to alter our practice. Additionally,we think that this is just ‘the tip of the iceberg’ in redefining how we treat reflux. As full time practicing physicians, we have seen many patients that need antibiotics, some that do not need antibiotics, and other that need surgery. It is our hope that we continue to take a scientific approach to this problem and these children can be categorized based on risk factors and receive individualized treatment that will decrease their risk for further problems References: 1.Marco Pennesi, Laura Travan, Leopoldo Peratoner, Andrea Bordugo, Adriano Cattaneo, Luca Ronfani, Silvia Minisini, Alessandro Ventura for the North East Italy Prophylaxis in VUR study group .Is Antibiotic Prophylaxis in Children With Vesicoureteral Reflux Effective in Preventing Pyelonephritis and Renal Scars? A Randomized, Controlled Trial.Pediatrics 2008; 121: e1489-e1494 2.Lee SJ, Shim YH, Cho SJ, Lee JW.Probiotics prophylaxis in children with persistent primary vesicoureteral reflux. Pediatr Nephrol 2007 Sep;22(9):1315-20.[Epub 2007 May 26] 3.Williams GJ, Lee A, Craig JC.Long-term antibiotics for preventing recurrent urinary tract infection in children.Cochrane Database Syst Rev. 2001;(4):CD001534. Review. Update in: CochraneDatabase Syst Rev. 2006;3:CD001534 4.Wald ER. Urinary antibiotic prophylaxis may not be required in children with mild ormoderate vesicoureteral reflux following acute pyelonephritis.J Pediatr 2006 Sep;149(3):421-2 5.Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R.Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials.JAMA 2007 Jul 11;298(2):179- 86 Conflict of Interest: None declared