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Equivocal study results and limited evidence have swung the pendulum away from performing voiding cystourethrograms (VCUGs) and administering antibiotic prophylaxis in children with febrile urinary tract infections (UTIs). Now, the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) study has been published. Researchers at 19 U.S. centers randomized 607 children (age range, 2–71 months; primarily white, female, and commercially insured) with a first (91%) or second febrile (86%) or symptomatic UTI and vesicoureteral reflux (VUR, grades I–IV) to receive daily prophylaxis with trimethoprim-sulfamethoxazole or placebo. Adherence was good: 77% of children took the study medication 75% of the time.
At 2-year follow-up, febrile…