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Antibiotic prophylaxis may not decrease risk of recurrent UTI in children

Clinical Question:
Does antibiotic prophylaxis reduce the risk of recurrent urinary tract infection in children?

Bottom Line:
In a cohort of otherwise healthy children with a first urinary tract infection (UTI), antibiotic prophylaxis exposure was not associated with a reduced risk of recurrent UTI. Antibiotic exposure did, however, increase the risk of treatment-resistant pathogens. (LOE = 2b)

Reference:
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;298:179-186.  [PMID:17622599]

Study Design:
Cohort (retrospective)

Setting:
Outpatient (any)

Synopsis:
Although evidence of benefit is limited, clinicians commonly prescribe antibiotics to prevent recurrent UTIs in children. These investigators analyzed a cohort of children, aged 6 years or younger, with a first UTI from 27 primary care pediatric practices in the United States that share a common electronic health record. To minimize lost data, researchers also searched both electronic and paper charts for information obtained from out-of-network hospitals and clinics. The authors do not state whether individuals assessing outcomes remained masked to the study hypothesis. However, independent data validation occurred by randomly comparing 5% of abstracted information with the medical record. Agreement occurred with 95% of the data. Recurrent UTI was defined as a second positive urine culture obtained at least 2 weeks after completing therapy for the first UTI. From a total of 74,974 children seen for at least 2 clinic visits, 666 otherwise healthy children had a confirmed first UTI. Of these, 611 children underwent at least 24 days of follow-up. Nearly 90% of these children were female. Recurrent UTI occurred in 83 children (12% per year), with 51 (61%) of these recurrent infections caused by pathogens resistant to one or more antimicrobials. Using both univariate and multivariate analytic methods, factors associated with an increased risk of recurrent UTI included white race, aged 2 years or older, and grade 4 to 5 vesicoureteral reflux. Antibiotic prophylaxis exposure was not associated with a reduced risk of recurrent infection, but was significantly related to an increased risk of resistant infection.

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