Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children

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Introduction A brief history of antibiotics for UTI Prophylaxis • Why? ▫ 2% of boys, 8% of girls by age 7 ▫ Between 830% experience recurrent UTI* ▫ Longterm morbidity with renal damage in 5% of kids • The debate: ▫ Pro: Antibiotics have long been used to prevent recurrent UTI – in VUR and in recurrent UTI ▫ Con: Doesn’t it just create multidrug resistant infections, and does it really prevent end organ damage? And the side effects?
Sample of articles in past on ppx: • Saux et al. CMAJ 2000 ▫ Minimeta (6 case and cohort studies of quality 02/5) ▫ Normal GU (Tx group: 04.0 per 10 patientyears vs. 4.016.7 for control) ▫ Neurogenic bladders (tx group: 2.9 and 17.1 per 10 patientyears vs 1.5 and 33.0 for the control groups) ▫ Concluded data severely lacking • Williams et al. Cochrane Database Syst Rev. 2006 ▫ Reviewed 8 studies comparing antibiotics, and comparing abx with placebo ▫ One said nitrofurantoin better than TMPSMX, but had worse adherence from side effects ▫ Another said cefixime better than nitrofurantoin, but more adverse effects ▫ Review of 5, gives RR 0.44 of recurrent positive urine culture with abx ▫ more studies needed.
Page 1 and 2: Antibiotic Prophylaxis and Recurren
Page 3: Outline • Introduction • Method
Page 8 and 9: • Essentially, there are no RCT r
Page 10 and 11: Methods • Four centers in Austral
Page 12 and 13: Inclusion Criteria • Children who
Page 14 and 15: Patient enrollment
Page 16 and 17: Imaging • Not required, performed
Page 18 and 19: Adherence • Assessed at 3 month i
Page 20 and 21: Primary and Secondary outcomes •
Page 22 and 23: Statistical Analysis • UTI ▫ Ti
Page 24 and 25: Statistical Analysis • Cox model
Page 26: Patient Characteristics
Page 29 and 30: Time to symptomatic UTI for all pat
Page 31 and 32: Effect of antibiotics on risk for s
Page 33 and 34: Time to symptomatic UTI
Page 35 and 36: Discussion • The benefit of thera
Page 37 and 38: Recent changes • Five randomized,
Page 39 and 40: Limitations • Study not powered t
Page 41 and 42: Conclusions • Long term, lowdos

Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children

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