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KMID : 1218220100020010001
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Korean Journal of Pediatric Urology
2010 Volume.2 No. 1 p.1 ~ p.8
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The Use of Prophylactic Antibiotics in Pediatric Urinary Tract Infection: Indication, Effect and Future Perspective
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Park Jae-Shin
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Abstract
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Many children with urinary tract infection (UTI) and urinary tract abnormality such as vesicoureteral reflux (VUR) are given prophylactic antibiotic to prevent recurrence of UTI and permanent kidney damage. Occasionally, children with normal urinary tract receive prophylactic antibiotic to alleviate the patient suffering and family inconvenience associated with recurrent symptomatic UTI. These recommendations are mostly opinion based and are derived from studies that were not randomized and were done before the current renal imaging modalities became available. Recent studies have raised serious doubts about the role of antibiotic prophylaxis after UTI by demonstrating the presence of preexisting renal scars without UTI in some patients, systematic reviews of published literature on UTI and VUR, and by comparing randomized patients with VUR who received antibiotic prophylaxis with those who did not receive any prophylaxis. However, the new knowledge has also highlighted that, apart from skilful management of individual patients, well designed studies are needed to answer the questions on antibiotic prophylaxis across the spectrum of UTI in different clinical situations. One such study currently underway is the Randomized Intervention for Children With Vesicoureteral Reflux study, which will evaluate the role of antibiotic prophylaxis in preventing recurrent UTI and renal scarring in young children with VUR. So, it is advisable that until the results of more appropriately designed studies become available, UTI in young children is considered as a risk factor for renal scarring and each patient is treated with prudence. Regarding antibiotic prophylaxis for antenatal hydronephrosis, routine use is not recommended, but families should receive education on signs and symptoms of UTIs to allow prompt diagnosis and treatment should s UTI occur.
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KEYWORD
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Prophylactic antibiotic, Urinary tract infection, Vesicoureteral reflux, Antenatal hydronephrosis
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