Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children

October 29, 2009 at 11:34 am Leave a comment

N Engl J of Medicine  Oct 29, 2009  V.361  N.18  p.1748-1759

Jonathan C. Craig, M.B., Ch.B., Ph.D., Judy M. Simpson, Ph.D., Gabrielle J. Williams, Ph.D., M.P.H., Alison Lowe, B.Sc., Graham J. Reynolds, M.B., B.S., Steven J. McTaggart, M.B., B.S., Ph.D., Elisabeth M. Hodson, M.B., B.S., Jonathan R. Carapetis, M.B., B.S., Ph.D., Noel E. Cranswick, M.B., B.S., Grahame Smith, M.B., B.S., Les M. Irwig, M.B., B.Ch., Ph.D., Patrina H.Y. Caldwell, Ph.D., Sana Hamilton, M.P.H., Leslie P. Roy, M.B., B.S., for the Prevention of Recurrent Urinary Tract Infection in Children with Vesicoureteric Reflux and Normal Renal Tracts (PRIVENT) Investigators

Background Antibiotics are widely administered to children with the intention of preventing urinary tract infection, but adequately powered, placebo-controlled trials regarding efficacy are lacking. This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy prevents urinary tract infection in predisposed children.

Methods We randomly assigned children under the age of 18 years who had had one or more microbiologically proven urinary tract infections to receive either daily trimethoprim–sulfamethoxazole suspension (as 2 mg of trimethoprim plus 10 mg of sulfamethoxazole per kilogram of body weight) or placebo for 12 months. The primary outcome was microbiologically confirmed symptomatic urinary tract infection. Intention-to-treat analyses were performed with the use of time-to-event data.

Results From December 1998 to March 2007, a total of 576 children (of 780 planned) underwent randomization. The median age at entry was 14 months; 64% of the patients were girls, 42% had known vesicoureteral reflux (at least grade III in 53% of these patients), and 71% were enrolled after the first diagnosis of urinary tract infection. During the study, urinary tract infection developed in 36 of 288 patients (13%) in the group receiving trimethoprim–sulfamethoxazole (antibiotic group) and in 55 of 288 patients (19%) in the placebo group (hazard ratio in the antibiotic group, 0.61; 95% confidence interval, 0.40 to 0.93; P=0.02 by the log-rank test). In the antibiotic group, the reduction in the absolute risk of urinary tract infection (6 percentage points) appeared to be consistent across all subgroups of patients (P0.20 for all interactions).

Conclusions Long-term, low-dose trimethoprim–sulfamethoxazole was associated with a decreased number of urinary tract infections in predisposed children. The treatment effect appeared to be consistent but modest across subgroups

 

abstract

http://content.nejm.org/cgi/content/short/361/18/1748?query=TOC

 

PDF

http://content.nejm.org/cgi/reprint/361/18/1748.pdf

 

Editorial

Antimicrobial Prophylaxis for Urinary Tract Infection in Children

Alejandro Hoberman, M.D., and Ron Keren, M.D., M.P.H.

abstract

http://content.nejm.org/cgi/content/short/361/18/1804?query=TOC

PDF

http://content.nejm.org/cgi/reprint/361/18/1804.pdf

Entry filed under: Antimicrobianos, Bacterias, Infecciones urinarias.

Outcome of Acute Prosthetic Joint Infections Due to Gram-Negative Bacilli Treated with Open Debridement and Retention of the Prosthesis REVIEW ARTICLE – Norovirus Gastroenteritis

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

Trackback this post  |  Subscribe to the comments via RSS Feed


Calendar

October 2009
M T W T F S S
 1234
567891011
12131415161718
19202122232425
262728293031  

Most Recent Posts


%d bloggers like this: