Antimicrobial prophylaxis for children with vesicoureteral reflux

This is a multi-centric randomized controlled trial [1] comparing cotrimoxazole prophylaxis versus no prophylaxis in children (<6 years old) with vesicoureteral reflux (VUR) detected after a first or second episode of urinary tract infection (UTI). The trial was designed to determine efficacy in preventing recurrence of UTI and renal scarring, as well as antibiotic resistance patterns. It was conducted across 19 sites in the United States, recruiting subjects over nearly five years, with follow-up for at least two years. Among 86% children who completed the study, the investigators observed lower recurrence of UTI in the intervention group (14.8%) in comparison to controls (27.4%). Intention-totreat analysis showed similar results but lesser magnitude of difference (25.5% vs 37.4%). However, there was no difference in the incidence of renal scarring (new scarring or worsening of pre-existing scarring); 11.9% and 10.2% in the intervention and control groups, respectively. The prevalence of antibiotic resistance increased significantly with prophylaxis. The investigators concluded that antibiotic prophylaxis is useful to prevent repeat episodes of UTI in children with VUR.