Small benefit for low-dose antibiotics to prevent repeat symptomatic urinary tract infection in children

Wednesday 11 December 2019

Brian McAvoy

PEARLS No.

640

Clinical question

Compared with placebo/no treatment, how effective are long-term prophylactic antibiotics for preventing recurrence of urinary tract infection in children?

Bottom line

Long‐term antibiotics reduced the risk of repeat symptomatic UTI in children who had one or more previous UTIs, but the benefit was small. A single study reported event time periods and showed the greatest risk of repeat symptomatic infection occurred in the 3 to 6 months following the initial UTI. Nitrofurantoin appeared the most effective treatment but led to considerable adverse events.

Caveat

The data showed few adverse effects from the antibiotic treatment but demonstrated an increased risk of bacterial resistance to the treatment drug in subsequent infections.

Context

UTI is common in children. Due to acute illness caused by UTI and the risk of pyelonephritis‐induced permanent kidney damage, many children are given long‐term (several months to 2 years) antibiotics aimed at preventing recurrence.

Cochrane Systematic Review

Williams G et al. Long-term antibiotics for preventing urinary tract infections in children. Cochrane Reviews, 2019, Issue 4. Art. No.: CD001534. DOI: 10.1002/14651858. CD001534.pub4. This review contains 16 studies involving 2036 participants.

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How to Treat

+How to treat

Polypharmacy

For older people and frail people, the long-term benefit of medicines reduces and the potential for harm from adverse effects increases. When the benefit–risk balance changes in this way, medicine review and optimisation are important to simplify the therapeutic regimen, reduce inappropriate medicines and minimise risks. In this article, pharmacist prescriber Linda Bryant uses two case studies to illustrate important considerations during medicine reviews

Wednesday 28 May 2025, 12:50 AM