Do Prophylactic Antibiotics Prevent Children’s UTIs?

In the U.S., an estimated 70,000 to 180,000 children (3%–7% of girls, 1%–2% of boys) develop a urinary tract infection (UTI) by age 6. Guidelines recommend imaging to evaluate for the presence and degree of vesicoureteral reflux (VUR; thought to increase the risk for renal scarring) and, for children with VUR, prophylactic antibiotics to prevent recurrent infections. However, data are limited regarding the risk factors for recurrent UTIs in children and the risks and benefits of antibiotic prophylaxis. To shed light on these issues, investigators analyzed records from 27 primary care pediatric practices linked by a common electronic health record system.

Of 74,974 children aged ≤6 in the network, 611 were diagnosed with a first UTI — and had at least one additional clinic visit ≥24 days after diagnosis — between July 2001 and May 2006. Among these children, 83 had a recurrent UTI (recurrent UTI incidence rate, 0.12 per person-year). Factors significantly associated with risk for recurrence included white race, age 3–4 or 4–5, and grade 4 or 5 VUR. Antibiotic prophylaxis was not associated with decreased risk for recurrent UTI; instead, it was associated with a significantly increased risk for infection with an antimicrobial-resistant organism (hazard ratio, 7.5; 95% confidence interval, 1.6–35.2).