Study: Prophylactic treatment of children with UTIs not beneficial

The use of prophylactic antibiotics after an initial urinary tract infection is not associated with reduced risk of recurrent UTIs, but is associated with an increased risk of resistant infections, according to a new study from the University ofPennsylvania Robert Wood Johnson Clinical Scholars Program, Philadelphia.

Researchers conducted a study to identify risk factors for recurrent UTI and to estimate the effectiveness and possibility of resistance of antimicrobials in preventing recurrent UTI. Patients in the study were from a Children’s Hospital of Philadelphia network of primary care pediatric practices, with children between the ages of birth and 6 years who were diagnosed with first UTI between July 2001 and May 2006.

Among nearly 75,000 children in the network, 611 had a first UTI and 83 had a recurrent UTI. Sex, grade 1 to 3 vesicoureteral reflux, and other antibiotic exposure had no effect on risk of recurrent UTI. Exposure to prophylactic antibiotics significantly increased the likelihood of resistant infections (7.5 times increased risk), as reported in JAMA (2007; 298:179-86).

“Given... previous findings and the unfavorable risk/benefit ratio demonstrated by the current study, we think it is prudent for clinicians to discuss the risks and unclear benefits of prophylaxis with families as they make family-centered decisions about whether to start prophylactic [antibiotics] or to closely monitor a child without prescribing [antibiotic] prophylaxis after a first UTI,” wrote the authors, led by Patrick H. Conway, MD, MSc.