Continuous Antibiotic Prophylaxis Beneficial in Preventing UTIs in Infants with vesicoureteral reflux

Urinary tract infections (UTIs) can be a serious concern in infants, especially those with grade III, IV, or V vesicoureteral reflux. There has been ongoing debate about the effectiveness of continuous antibiotic prophylaxis in preventing UTIs in this patient population. A recent randomised, open-label trial as published in The New England Journal Of Medicine by William Morello and colleagues conducted across 39 European centers sought to shed light on this matter.

The study included infants aged 1 to 5 months with grade III, IV, or V vesicoureteral reflux and no previous UTIs. Participants were randomly assigned to either receive continuous antibiotic prophylaxis or no treatment for 24 months.

● In the group receiving prophylaxis, 21.2% of participants experienced their first UTI during the trial.

● In the untreated group, 35.6% of participants had their first UTI.

● Continuous antibiotic prophylaxis reduced the risk of a first UTI by 45% compared to no treatment.

● The number needed to treat for 2 years to prevent one UTI was 7 children.

● However, it's noteworthy that among untreated participants, 64.4% did not develop a UTI during the study.

● The incidence of new kidney scars and estimated glomerular filtration rate (GFR) at 24 months did not significantly differ between the two groups.

● UTI isolates from the prophylaxis group were more likely to be non-Escherichia coli organisms and showed antibiotic resistance.

● Serious adverse events occurred at similar rates in both groups.

These findings suggest that continuous antibiotic prophylaxis offers a modest yet significant benefit in preventing a first UTI in infants with grade III, IV, or V vesicoureteral reflux and no prior UTIs. However, it's important to consider the potential for increased occurrences of non-E. coli organisms and antibiotic resistance. Clinicians should weigh the risks and benefits when deciding on prophylactic antibiotic therapy for these young patients.

Reference:

Morello, W., Baskin, E., Jankauskiene, A., Yalcinkaya, F., Zurowska, A., Puccio, G., Serafinelli, J., La Manna, A., Krzemień, G., Pennesi, M., La Scola, C., Becherucci, F., Brugnara, M., Yuksel, S., Mekahli, D., Chimenz, R., De Palma, D., Zucchetta, P., Vajauskas, D., … Montini, G. (2023). Antibiotic prophylaxis in infants with grade III, IV, or V vesicoureteral reflux. The New England Journal of Medicine, 389(11), 987–997. https://doi.org/10.1056/nejmoa2300161