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Antibiotic prophylaxis and recurrent urinary tract infection in children

Craig, Jonathan C., Simpson, Judy M., Williams, Gabrielle J., Lowe, Alison, Reynolds, Graham J., McTaggart, Steven J., Hodson, Elisabeth M., Carapetis, Jonathan R., Cranswick, Noel E., Smith, Grahame, Irwig, Les M., Caldwell, Patrina H. Y., Hamilton, Sana and Roy, Leslie P. (2009). Antibiotic prophylaxis and recurrent urinary tract infection in children. New England Journal of Medicine,361(18):1748-1759.

Document type: Journal Article
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IRMA ID 75039815xPUB36
Title Antibiotic prophylaxis and recurrent urinary tract infection in children
Author Craig, Jonathan C.
Simpson, Judy M.
Williams, Gabrielle J.
Lowe, Alison
Reynolds, Graham J.
McTaggart, Steven J.
Hodson, Elisabeth M.
Carapetis, Jonathan R.
Cranswick, Noel E.
Smith, Grahame
Irwig, Les M.
Caldwell, Patrina H. Y.
Hamilton, Sana
Roy, Leslie P.
Journal Name New England Journal of Medicine
Publication Date 2009
Volume Number 361
Issue Number 18
ISSN 0028-4793   (check CDU catalogue  open catalogue search in new window)
Start Page 1748
End Page 1759
Total Pages 12
Place of Publication Boston, United States
Publisher Massachusetts Medical Society
HERDC Category C1 - Journal Article (DEST)
Abstract 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 (P > or = 0.20 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.
DOI http://dx.doi.org/10.1056/NEJMoa0902295   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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