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Antibiotic prophylaxis may not help prevent recurrent urinary tract infections (UTI) in children, but treatment could increase the risk of drug resistance, according to a cohort study in primary care.
In 611 children aged 6 or less presenting with a first urinary tract infection, prophylaxis was not associated with a reduced risk of a recurrent infection (hazard ratio 1.01, 95% CI 0.5 to 2.02). In 83 children who did develop recurrent infections, prophylaxis was associated with an increased likelihood of antibiotic resistance (odds ratio 7.5, 1.60 to 35.17).
US guidelines recommend prophylaxis for children with a first urinary tract infection and vesico-ureteral reflux, despite mixed results from previous trials. These authors found no link between recurrence and grade 1-3 reflux, but their results for more severe disease were inconclusive. They suggest that doctors discuss the risks and benefits with families before prescribing prophylaxis. The alternative is close surveillance without antibiotics.
These authors found a lower rate of recurrent urinary tract infection (12% per year after a first infection) than previous studies in other populations. But they are confident that their estimate accurately reflects the incidence of symptomatic recurrent infection in primary care.