Antibiotic Prophylaxis for Vesicoureteral Reflux May Not Be Necessary

Vesicoureteral reflux (VUR) is common in children with urinary tract infections (UTIs). Current practice for pediatricians is to use a voiding cystourethrogram to check for VUR in patients with UTI, and if VUR is present, to recommend antibiotic prophylaxis (or surgery for high-grade VUR).

In this international, multisite trial, investigators randomized 236 children (age range, 3 months to 18 years) with acute pyelonephritis to receive daily antibiotic prophylaxis (with sulfamethoxazole-trimethoprim or nitrofurantoin) for 1 year or no prophylaxis. Of the 218 children who completed the trial, 113 had grade I–III reflux, and 105 did not have reflux. Acute pyelonephritis was diagnosed by the presence of fever, pyuria, positive urine culture, an…