Jose de Bessa1, Flavia Cristina de Carvalho Mrad2, Evilin Feitosa Mendes2, Marcia Carvalho Bessa2, Victor Pereira Paschoalin2, Ricardo Brianezi Tiraboschi2, Zein Mohamed Sammour2, Cristiano Mendes Gomes2, Luis H Braga2, José Murillo Bastos Netto2. 1. Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada. Electronic address: bessa.jr@terra.com.br. 2. Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
Abstract
PURPOSE: The followup and treatment of children with vesicoureteral reflux has been debated for many years. Antibiotic prophylaxis has a role for preventing urinary tract infection in these children. Recent studies and guidelines suggested that prophylaxis has little or no role in preventing urinary tract infection in those children, especially those with low grades (I and II) of reflux. MATERIALS AND METHODS: We analyzed all published randomized, controlled trials comparing antibiotic prophylaxis vs no prophylaxis or placebo in children with vesicoureteral reflux. The children were divided into those with nondilated (grades I and II) and dilated (grades III and IV) vesicoureteral reflux. After data were analyzed the RIVUR study was published and, therefore, it was added to the analyzed data. RESULTS: After analyzing the first published studies we found that antibiotic prophylaxis would be beneficial only in children with high grade vesicoureteral reflux. With the addition of the data in the RIVUR study these results changed. The new pooled data support antibiotic prophylaxis in all children with vesicoureteral reflux. CONCLUSIONS: Vesicoureteral reflux management is still controversial. In contrast to recently published studies and guidelines, this meta-analysis supports antibiotic prophylaxis in all children with vesicoureteral reflux regardless of reflux grade. More studies are needed to support this finding.
PURPOSE: The followup and treatment of children with vesicoureteral reflux has been debated for many years. Antibiotic prophylaxis has a role for preventing urinary tract infection in these children. Recent studies and guidelines suggested that prophylaxis has little or no role in preventing urinary tract infection in those children, especially those with low grades (I and II) of reflux. MATERIALS AND METHODS: We analyzed all published randomized, controlled trials comparing antibiotic prophylaxis vs no prophylaxis or placebo in children with vesicoureteral reflux. The children were divided into those with nondilated (grades I and II) and dilated (grades III and IV) vesicoureteral reflux. After data were analyzed the RIVUR study was published and, therefore, it was added to the analyzed data. RESULTS: After analyzing the first published studies we found that antibiotic prophylaxis would be beneficial only in children with high grade vesicoureteral reflux. With the addition of the data in the RIVUR study these results changed. The new pooled data support antibiotic prophylaxis in all children with vesicoureteral reflux. CONCLUSIONS: Vesicoureteral reflux management is still controversial. In contrast to recently published studies and guidelines, this meta-analysis supports antibiotic prophylaxis in all children with vesicoureteral reflux regardless of reflux grade. More studies are needed to support this finding.
Authors: Stephen Yang; Michael E Chua; Stuart Bauer; Anne Wright; Per Brandström; Piet Hoebeke; Søren Rittig; Mario De Gennaro; Elizabeth Jackson; Eliane Fonseca; Anka Nieuwhof-Leppink; Paul Austin Journal: Pediatr Nephrol Date: 2017-10-03 Impact factor: 3.714