Mesrur Selcuk Silay1, Shabnam Undre2, Arjun K Nambiar3, Hasan Serkan Dogan4, Radim Kocvara5, Rien J M Nijman6, Raimund Stein7, Serdar Tekgul4, Christian Radmayr8. 1. Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey. Electronic address: selcuksilay@gmail.com. 2. Department of Pediatric and Adult Urology, East and North Herts NHS Trust, Stevenage, UK. 3. Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK. 4. Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey. 5. Department of Urology, General Teaching Hospital and Charles University, 1st Faculty of Medicine in Praha, Prague, Czechia. 6. Department of Urology and Pediatric Urology, University Medical Centre Groningen, The Netherlands. 7. Department of Urology, University of Mainz, Germany. 8. Department of Urology, Medical University of Innsbruck, Austria.
Abstract
BACKGROUND: The benefits and harms of continuous antibiotic prophylaxis (CAP) versus observation in patients with antenatal hydronephrosis (ANH) are controversial. OBJECTIVE: The aim was to determine the effectiveness of CAP for ANH, and if beneficial to determine the best type and regimen of antibiotic and the most harmful to provide guidance for clinical practice. METHODS: A systematic literature search was performed in databases including Medline, Embase, and Cochrane in June 2015. The protocol was prospectively registered to PROSPERO (CRD42015024775). The search started from 1980, when maternal ultrasound was first introduced into clinical practice. Eligible studies were critically evaluated for risk of bias using Revman software. The outcomes included reduction in urinary tract infections (UTI), drug-related adverse events and kidney functions. RESULTS: Of 797 articles identified, 57 full text articles and six abstracts were eligible for inclusion (2 randomized controlled trials, 11 non-randomized comparative studies, and 50 case series). It remains unclear whether CAP is superior to observation in decreasing UTIs. No conclusion could be drawn for drug-related adverse events and kidney function because of lack of data. Children who were not circumcised, with ureteral dilatation, and high-grade hydronephrosis may be more likely to develop UTI, and CAP may be warranted for these subgroups of patients. A majority of the studies had low-to-moderate quality of evidence and with high risk of bias. CONCLUSIONS: The benefits of CAP in a heterogeneous group of children with ANH involving different etiologies remains unproven. However, the evidence in the form of prospective and retrospective observational studies has shown that it reduces febrile UTI in particular subgroups.
BACKGROUND: The benefits and harms of continuous antibiotic prophylaxis (CAP) versus observation in patients with antenatal hydronephrosis (ANH) are controversial. OBJECTIVE: The aim was to determine the effectiveness of CAP for ANH, and if beneficial to determine the best type and regimen of antibiotic and the most harmful to provide guidance for clinical practice. METHODS: A systematic literature search was performed in databases including Medline, Embase, and Cochrane in June 2015. The protocol was prospectively registered to PROSPERO (CRD42015024775). The search started from 1980, when maternal ultrasound was first introduced into clinical practice. Eligible studies were critically evaluated for risk of bias using Revman software. The outcomes included reduction in urinary tract infections (UTI), drug-related adverse events and kidney functions. RESULTS: Of 797 articles identified, 57 full text articles and six abstracts were eligible for inclusion (2 randomized controlled trials, 11 non-randomized comparative studies, and 50 case series). It remains unclear whether CAP is superior to observation in decreasing UTIs. No conclusion could be drawn for drug-related adverse events and kidney function because of lack of data. Children who were not circumcised, with ureteral dilatation, and high-grade hydronephrosis may be more likely to develop UTI, and CAP may be warranted for these subgroups of patients. A majority of the studies had low-to-moderate quality of evidence and with high risk of bias. CONCLUSIONS: The benefits of CAP in a heterogeneous group of children with ANH involving different etiologies remains unproven. However, the evidence in the form of prospective and retrospective observational studies has shown that it reduces febrile UTI in particular subgroups.
Authors: Corina Zamfir Snykers; Elea De Plaen; Sophie Vermersch; Manuel Lopez; Karim Khelif; Stephane Luyckx; Paul Philippe; Francois Varlet; Henri Steyaert Journal: Front Pediatr Date: 2019-09-25 Impact factor: 3.418
Authors: M Chad Wallis; Pangaja Paramsothy; Kimberly Newsome; Tonya Williams; Jonathan C Routh; David B Joseph; Earl Cheng; Duong Tu; J Chris Austin; Stacy T Tanaka; William O Walker; Kathryn A Smith; Michelle A Baum; John S Wiener Journal: J Urol Date: 2021-03-08 Impact factor: 7.600