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  • Title: Could prophylactic antibiotics be stopped in patients with history of vesicoureteral reflux?
    Author: Alconcher LF, Meneguzzi MB, Buschiazzo R, Piaggio LA.
    Journal: J Pediatr Urol; 2009 Oct; 5(5):383-8. PubMed ID: 19362059.
    Abstract:
    OBJECTIVE: To compare the incidence and type of urinary tract infection (UTI) in patients with primary vesicoureteral reflux (VUR) diagnosed after a febrile UTI while they were on prophylactic antibiotics (PA) and after stopping PA. MATERIALS AND METHODS: Criteria to discontinue PA were: no UTI during 12+ or more months on PA, old enough to communicate UTI symptoms, potty trained and absence of risk factors for UTI. Patients with at least 1 year of follow up without PA were included (n=77). We recorded: age at which PA was indicated and stopped, time on and off PA, incidence and type of UTI (cystitis vs acute pyelonephritis (APN)), and renal scan results. RESULTS: PA was started and stopped at a mean age of 18.5 and 61 months, respectively. Mean time on PA was 39 months (range 12-95): 25 patients had 44 UTI episodes (0.17 episodes/patient/year), and 31 (70%) of them were APN. Mean time of antibiotics was 44.5 months (range 12-162): 13 patients had 24 UTI episodes (0.08 episodes/patient/year), eight (33%) of which were APN (P<0.05). A renal scan was performed in 71 patients after the index infection and repeated in 12. Two patients lost renal function while still on PA. CONCLUSION: Discontinuing PA in patients with history of VUR is a safe practice and should be considered as a management option.
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