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Prophylactic antibiotic therapy often is recommended to prevent recurrent urinary tract infection (UTI). To determine whether prophylaxis lowers risk for UTI recurrence and to identify risk factors for recurrence, investigators followed a cohort of 75,000 children (age ≤6 years) seen at 27 U.S. primary care pediatric practices from 2001 to 2006.
The incidence of first UTI was 0.7% (611 children; 89% girls). Overall, 14% of children had recurrent infection (12% recurrence rate per year). Risk factors for recurrent UTI were white race, age 3 to 5 years at initial UTI, and grade 4 to 5 vesicoureteral reflux (VUR). Prophylactic antibiotic therapy was not associated with lower risk for recurrent UTI. However, in the cohort of 83 children with recurrent UTI, exposure to prophylactic antimicrobial agents significantly increased the likelihood of antibiotic-resistant infection.
Conway PH. Recurrent urinary tract infections in children: Risk factors and association with prophylactic antimicrobials. JAMA 2007 Jul 11; 298:179-86.
Comment
Given advances in medical technology, periodic reexamination of common medical problems is critical. For example, with modern pediatric urology and prenatal ultrasounds, the natural history following a first UTI might be quite different from that in previous decades. This study’s findings confirm that high-grade VUR is an important risk factor for recurrent UTI and suggest that antibiotic prophylaxis does not prevent recurrence. Furthermore, antibiotic exposure, not surprisingly, increases the risk for recurrent infections with resistant organisms. The investigators did not examine whether chronic antibiotic prophylaxis promotes resolution of VUR; however, results from recent studies challenge the benefits of antibiotic prophylaxis for VUR as well.