Prophylaxis With TMP-SMX Did Not Alter Risk for Non-UTI Infections

Daily prophylaxis with TMP-SMX was not associated with change in risk for skin and soft tissue or sino-pulmonary infections, or pharyngitis in children.

A secondary analysis of the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) cohort1 published in The Pediatric Infectious Disease Journal revealed that daily prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) was not associated with an increased or decreased risk for skin and soft tissue or sino-pulmonary infections, or pharyngitis in children.

A cohort of 607 otherwise healthy children age 2 to 71 months with grade I to IV vesicoureteral reflux were randomly assigned to receive TMP-SMX or placebo and followed for 2 years post-enrollment. 

At least once during the 2-year follow-up period, 10 patients had a skin and soft tissue infection, 44 had pharyngitis, and 48 had a sino-pulmonary infection. Patients receiving TMP-SMX were more frequently diagnosed with pharyngitis and less frequently with either skin and soft tissue or sino-pulmonary infections. These differences in diagnosis were not, however, statistically significant in univariate or multivariate analysis.

Of note, this data was limited by sample size but still suggests that children receiving daily TMP-SMX do not have an altered risk for common non-urinary tract infections. Investigators concluded that “these findings can be helpful to clinicians in providing parents with a more comprehensive assessment of the risks and benefits of initiating prolonged TMP-SMX UTI prophylaxis.”

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  1. Hoberman A, Greenfield SP, Mattoo TK, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. New Engl J Med. 2014; 370:2367-2376.
  2. Desai S, Fisher B. Impact of trimethoprim-sulfamethoxazole urinary tract infection prophylaxis on non-UTI infections [published online August 30, 2018]. Pediatr Infect Dis J. doi:10.1097/INF.0000000000002167