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2017 ; 11
(1-2Suppl1
): S20-S24
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English Wikipedia
Continuous antibiotic prophylaxis in the setting of prenatal hydronephrosis and
vesicoureteral reflux
#MMPMID28265311
Wong NC
; Koyle MA
; Braga LH
Can Urol Assoc J
2017[Jan]; 11
(1-2Suppl1
): S20-S24
PMID28265311
show ga
Continuous antibiotic prophylaxis (CAP) has traditionally been offered for
children with recurrent urinary tract infections (UTIs) or those at risk,
including children diagnosed with prenatal hydronephrosis (HN) and vesicoureteral
reflux (VUR). However, indications for antibiotic prophylaxis are controversial,
data on who should benefit from this therapy is conflicting and, thus, guidelines
are unable to provide conclusive recommendations. In the setting of prenatal HN,
although randomized trials are currently underway, most evidence is derived from
low- to moderate-quality observational studies. Although there is no benefit in
those with low-grade HN, a systematic review of the available studies showed that
high-grade HN patients on prophylaxis experienced fewer infections with an
estimated number needed to treat of 7. On the other hand, there are eight
randomized trials that have investigated the use of antibiotic prophylaxis in the
setting of VUR. Although four of the studies have demonstrated some value of
prophylaxis and the other four have not, meta-analysis has shown an overall
benefit of antibiotic prophylaxis in preventing infections. The observed
differences are likely due to different inclusion criteria and study
heterogeneity. Although generalizing results of meta-analyses to all children is
tempting, an individualized approach, by determining which patients best behave
like those of the included studies, is recommended.