Long-term prophylactic antibiotic therapy for recurrent urinary tract infections in children

The objective of the new Cochrane Renal Group systematic review was to establish the efficacy and safety of long-term prophylactic use of antibiotics to prevent recurrence of urinary tract infections ( IVU) in children.

Acute MVP infections are quite common in children. At the age of 7 years, 8.4% of girls and 1.7% of boys suffer from at least 1 episode of UTI. Symptoms in young children are often not localized, but systemic and are characterized by fever, anorexia, lethargy and vomiting. In more than 80% of cases, urinary tract infections are caused by E.coli. Because of the expressed pain caused by UTI and the risk of developing permanent kidney damage induced by pyelonephritis, many children receive long-term antibiotic therapy to prevent the development of relapses. However, with such treatment, undesirable drug reactions and the development of resistance in microorganisms can occur.

The search was performed in the following databases: MEDLINE (1966 - January 2001), EMBASE (1988 - January 2001) and Cochrane Controlled Trials Register.

The review included randomized controlled trials with no language restrictions that compared 2 or more antibiotics and a placebo to one or more antibiotics for the prevention of recurrent urinary tract infections.

3 studies were found with a total of 151 participants who compared antibiotic therapy to placebo or no treatment. The duration of prophylactic use of antibiotics ranged from 10 weeks to 12 months. The average recurrence rate of urinary tract infections in the placebo groups was 63% (48/76). Compared to placebo (or no treatment), antibiotics reduce the risk of relapse of UTI. In the studies reviewed, no adverse drug events were recorded.

A single double-blind controlled study compared the effectiveness of two antibiotics in preventing the recurrence of urinary tract infections. It has been found that the use of nitrofurantoin for the prevention of recurrent urinary tract infections for more than 6 months is more effective than trimethoprim, however, in patients receiving nitrofurantoin, treatment was more often discontinued by due to the development of adverse drug events (mainly from the gastrointestinal tract) as patients taking trimethoprim.

So in the majority of studies published to date, there were design flaws, as well as systematic errors, known as re-evaluation of the true therapeutic effect, so it is necessary to conduct large double-blind studies properly organized to finally establish the effectiveness of the prescription of long-term antibiotics for the prevention of recurrence of UTI in children.