Table of Contents Author Guidelines Submit a Manuscript
Advances in Urology
Volume 2008, Article ID 217805, 5 pages
http://dx.doi.org/10.1155/2008/217805
Review Article

Antibiotic Prophylaxis for Children with Primary Vesicoureteral Reflux: Where Do We Stand Today?

1Antibiotic Management Team, University Hospital Leuven Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
2Department of Pediatric Nephrology and Organ Transplantation, University Hospital Leuven Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
3Department of Pediatric Nephrology, University Hospital Leuven Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
4Department of Pediatric Urology, University Hospital Leuven Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium

Received 30 April 2008; Revised 2 July 2008; Accepted 7 July 2008

Academic Editor: Hiep Nguyen

Copyright © 2008 Michiel Costers et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The main goal of the management of vesicoureteral reflux (VUR) is prevention of recurrent urinary tract infections (UTIs), and thereby prevention of renal parenchymal damage possibly ensuing from these infections. Long-term antibiotic prophylaxis is common practice in the management of children with VUR, as recommended in 1997 in the guidelines of the American Urological Association. We performed a systematic review to ascertain whether antibiotics can be safely discontinued in children with VUR and whether prophylaxis is effective in the prevention of recurrent UTIs and renal damage in these patients. Several uncontrolled studies indicate that antibiotic prophylaxis can be discontinued in a subset of patients, that is, school-aged children with low-grade VUR, normal voiding patterns, kidneys without hydronephrosis or scars, and normal anatomy of the urogenital system. Furthermore, a few recent randomized controlled trials suggest that antibiotic prophylaxis offers no advantage over intermittent antibiotic therapy of UTIs in terms of prevention of recurrent UTIs or new renal damage.