Long-Term, Prophylactic Antibiotics for UTIs Offer Little Benefit in Children

Long-term antibiotics to prevent recurrent urinary tract infections (UTIs) in children offer a modest benefit but may increase the occurrence of UTIs caused by resistant bacteria, according to study results published in Cochrane Database of Systematic Reviews.

Acute UTIs are common in children, with 8.4% of girls and 1.7% of boys having at least 1 episode by age 7 years. Although mortality is a rare complication of UTIs, hospitalization is required in approximately 40% of cases, particularly in infants. However, children who have a history of 1 infection are at risk for further infections and recurrent UTIs occur in up to 30% of patients, typically more often in girls than boys. Although low-dose antibiotic prophylaxis has been used to prevent recurring UTIs in children for many years, previous studies have suggested that some children on prophylactic antibiotics experience a recurrence, which raises concerns about bacterial resistance to such long-term antibiotic use. Therefore, this study assessed whether long-term antibiotic prophylaxis was more effective than placebo/no treatment in preventing the recurrence of UTIs in children, and if so, which antibiotics in clinical use were the most effective.

In total, 16 studies were included after a review of electronic databases of randomized controlled trials that compared low-dose antibiotics given for at least 2 months with no treatment or placebo in children at risk for a UTI. A total of 2036 children (age <18 years) were randomly assigned to treatment vs placebo groups and data from 1977 children were analyzed were included in the study. The primary outcome was the number of repeat symptomatic UTIs in combination with positive urine culture findings while receiving treatment/placebo. A random-effects model was used to estimate the risk ratio and risk difference for recurrent UTIs with 95% CIs.

Compared with no treatment/placebo, antibiotic use resulted in a modest decrease in the number of repeat symptomatic UTIs, with a 6% reduced risk for repeat symptomatic UTIs following a 12-month course of low-dose antibiotics. However, when data from all the included studies were combined, the CI suggested low precision, which indicated that antibiotics may make little to no difference in the risk for repeat infection.

Further, 3 studies reported data showing this was also associated with 2.5-fold greater risk for a repeat infection caused by a bacterium resistant to the treatment antibiotic in children on antibiotics compared with children on placebo. However, the CI, again, showed low precision, which indicated there may be little to no difference between the 2 groups. The studies suggested that the most effective antibiotic treatment for UTI prevention was nitrofurantoin, but it was associated with more adverse events than trimethoprim-sulphamethoxazole.

Overall, the study authors concluded that, “These findings suggest a small benefit to treating children who have had at least one UTI but for many children in the studies, no further UTIs occurred. Future research could focus on exploring and identifying which children are most likely to benefit from treatment.”

Reference

Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children [published online April 1, 2-19]. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001534.pub4