Background: The management of febrile urinary tract infection (fUTI) in patients with vesicoureteral reflux (VUR) is crucial to prevent renal scarring. Continuous antibiotic prophylaxis (CAP) is the most widely used initial treatment for VUR. However, the optimal duration of CAP is still unclear. We aimed to clarify an appropriate patient population and the optimal timing to discontinue CAP. Methods: We reviewed the records of 247 patients with primary VUR between January 2000 and December 2015. Seventy-two patients who discontinued CAP despite persistent VUR were enrolled. Kaplan-Meier method and Cox proportional hazard model was used in statistical analysis. Results: Following the discontinuation of CAP, fUTI developed in 25 patients after a median of 9 months (range 0–81). VUR resolved spontaneously in 9 out of 47 patients without recurrence during follow-up. Multivariate analysis showed bilateral VUR and duration of CAP of less than 1 year after the last fUTI were significant risk factors for recurrence. Conclusion: Among the risk factors examined, patients administered CAP for less than 1 year after the last fUTI and those with bilateral VUR had significantly more frequent recurrence. Our study suggests that the administration of CAP for more than 1 year after the last fUTI is beneficial in avoiding recurrent fUTI.

Keywords:
Continuous antibiotic prophylaxis, Febrile urinary tract infection, Risk factors, Vesicoureteral reflux
1.
Peters CA, Skoog SJ, Arant BS Jr, Copp HL, Elder JS, Hudson RG, et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children.
J Urol
. 2010 Sep; 184(3): 1134–44.
2.
Ransley PG, Risdon RA. The pathogenesis of reflux nephropathy.
Contrib Nephrol
. 1979; 16: 90–7.
3.
Alconcher LF, Meneguzzi MB, Buschiazzo R, Piaggio LA. Could prophylactic antibiotics be stopped in patients with history of vesicoureteral reflux?
J Pediatr Urol
. 2009 Oct; 5(5): 383–8.
4.
Al-Sayyad AJ, Pike JG, Leonard MP. Can prophylactic antibiotics safely be discontinued in children with vesicoureteral reflux?
J Urol
. 2005 Oct; 174(4 Pt 2): 1587–9.
5.
Cooper CS, Chung BI, Kirsch AJ, Canning DA, Snyder HM 3rd. The outcome of stopping prophylactic antibiotics in older children with vesicoureteral reflux.
J Urol
. 2000 Jan; 163(1): 269–72.
6.
Georgaki-Angelaki H, Kostaridou S, Daikos GL, Kapoyiannis A, Veletzas Z, Michos AG, et al. Long-term follow-up of children with vesicoureteral reflux with and without antibiotic prophylaxis.
Scand J Infect Dis
. 2005; 37(11-12): 842–5.
7.
Kitchens DM, Herndon A, Joseph DB. -Outcome after discontinuing prophylactic antibiotics in children with persistent vesicoureteral reflux.
J Urol
. 2010 Oct; 184(4 Suppl): 1594–7.
8.
Leslie B, Moore K, Salle JL, Khoury AE, Cook A, Braga LH, et al. Outcome of antibiotic prophylaxis discontinuation in patients with persistent vesicoureteral reflux initially presenting with febrile urinary tract infection: time to event analysis.
J Urol
. 2010 Sep; 184(3): 1093–8.
9.
Moriya K, Mitsui T, Kitta T, Nakamura M, Kanno Y, Kon M, et al. Early discontinuation of antibiotic prophylaxis in patients with persistent primary vesicoureteral reflux initially detected during infancy: outcome analysis and risk factors for febrile urinary tract infection.
J Urol
. 2015 Feb; 193(2): 637–42.
10.
Thompson RH, Chen JJ, Pugach J, Naseer S, Steinhardt GF. Cessation of prophylactic antibiotics for managing persistent vesicoureteral reflux.
J Urol
. 2001 Oct; 166(4): 1465–9.
11.
Medical versus surgical treatment of primary vesicoureteral reflux: a prospective international reflux study in children.
J Urol
. 1981 Mar; 125(3): 277–83.
12.
Smellie JM, Hodson CJ, Edwards D, Normand IC. CLINICAL AND RADIOLOGICAL FEATURES OF URINARY INFECTION IN CHILDHOOD.
BMJ
. 1964 Nov; 2(5419): 1222–6.
13.
Smellie JM, Katz G, Grüneberg RN. Controlled trial of prophylactic treatment in childhood urinary-tract infection.
Lancet
. 1978 Jul; 2(8082): 175–8.
14.
Olbing H, Claësson I, Ebel KD, Seppänen U, Smellie JM, Tamminen-Möbius T, et al. Renal scars and parenchymal thinning in children with vesicoureteral reflux: a 5-year report of the International Reflux Study in Children (European branch).
J Urol
. 1992 Nov; 148(5 Pt 2): 1653–6.
15.
Wang HH, Gbadegesin RA, Foreman JW, Nagaraj SK, Wigfall DR, Wiener JS, et al. Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: systematic review and meta-analysis.
J Urol
. 2015 Mar; 193(3): 963–9.
16.
Brandström P, Hansson S. Long-term, low-dose prophylaxis against urinary tract infections in young children.
Pediatr Nephrol
. 2015 Mar; 30(3): 425–32.
17.
Elder JS. Guidelines for consideration for surgical repair of vesicoureteral reflux.
Curr Opin Urol
. 2000 Nov; 10(6): 579–85.
18.
Tekgül S, Riedmiller H, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, et al.; European Association of Urology. EAU guidelines on vesicoureteral reflux in children.
Eur Urol
. 2012 Sep; 62(3): 534–42.
19.
Hideshi M, Manabu O, Yoshiaki K, Takahisa K, Yasuhiro A, Kiyohide S, et al. VUR guideline in children.
Jpn J Pediatr Urol
. 2016; 25: 122–70.
20.
Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, Pohl HG, et al.; RIVUR Trial Investigators. Antimicrobial prophylaxis for children with vesicoureteral reflux.
N Engl J Med
. 2014 Jun; 370(25): 2367–76.
21.
Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L, et al. Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring.
Pediatrics
. 2015 Jul; 136(1):e13–21.
22.
Shaikh N, Hoberman A, Keren R, Gotman N, Docimo SG, Mathews R, et al. Recurrent Urinary Tract Infections in Children With Bladder and Bowel Dysfunction.
Pediatrics
. 2016 Jan; 137(1): 137.
© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.