UroToday - This study by Dr. Chi-Hui Cheng et al. evaluated antibiotic resistance patterns of community-acquired urinary tract infections in children with vesicoureteral reflux specific prophylactic antibiotic therapies. They evaluated 420 children on prophylaxis between 2 institutions and documented breakthrough urinary tract infections from both hospitals.

They found that children receiving cephalosporin prophylaxis were more likely to have bacteria other than E. coli for breakthrough urinary tract infections with more multi-drug resistant pathogens, and therefore they recommended not using cephalosporins as prophylaxis. Overall in their study, they found that co-trimoxazole was an excellent prophylactic agent for vesicoureteral reflux with the lowest occurrences of breakthrough UTI.

It seems to me that even in my practice, Bactrim is well tolerated by the majority of patients. The interesting question would be which of these children would have broken through on their own, and is the antibiotic agent truly the factor that is causing these bacteria to transform themselves to a multi-drug resistant pathogen? Even though it has been proven that prophylaxis is quite safe, one must believe that getting these children off antibiotic prophylaxis has to be beneficial. We will anxiously await the results of the multi-center randomized trial of the RIVUR study to truly see if antibiotic prophylaxis is beneficial or not.

Cheng CH, Tsai MH, Huang YC, Su LH, Tsau YK, Lin CJ, Chiu CH, Lin TY
Pediatrics. 2008 Dec;122(6):1212-7
doi:10.1542/peds.2007-2926

UroToday Medical Editor Pasquale Casale, MD

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