Antibiotic prophylaxis and recurrent urinary tract infection in children

Craig, Jonathan C., Simpson, Judy M., Williams, Gabrielle J., Lowe, Alison, Reynolds, Graham J., McTaggart, Steven J., Hodson, Elisabeth M., Carapetis, Jonathan R., Cranswick, Noel E., Smith, Grahame, Irwig, Les M., Caldwell, Patrina H. Y., Hamilton, Sana and Roy, Leslie P. (2009) Antibiotic prophylaxis and recurrent urinary tract infection in children. New England Journal of Medicine, 361 18: 1748-1759. doi:10.1056/NEJMoa0902295

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Author Craig, Jonathan C.
Simpson, Judy M.
Williams, Gabrielle J.
Lowe, Alison
Reynolds, Graham J.
McTaggart, Steven J.
Hodson, Elisabeth M.
Carapetis, Jonathan R.
Cranswick, Noel E.
Smith, Grahame
Irwig, Les M.
Caldwell, Patrina H. Y.
Hamilton, Sana
Roy, Leslie P.
Title Antibiotic prophylaxis and recurrent urinary tract infection in children
Journal name New England Journal of Medicine   Check publisher's open access policy
ISSN 0028-4793
1533-4406
Publication date 2009-10-29
Year available 2009
Sub-type Article (original research)
DOI 10.1056/NEJMoa0902295
Open Access Status File (Publisher version)
Volume 361
Issue 18
Start page 1748
End page 1759
Total pages 12
Editor Drazen, J
Curfman, G
Morrissey, S
Place of publication Boston, MA, United States
Publisher Massachusetts Medical Society
Language eng
Subject C1
920501 Child Health
111704 Community Child Health
Formatted abstract
BACKGROUND: Antibiotics are widely administered to children with the intention of preventing urinary tract infection, but adequately powered, placebo-controlled trials regarding efficacy are lacking. This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy prevents urinary tract infection in predisposed children.
METHODS: We randomly assigned children under the age of 18 years who had had one or more microbiologically proven urinary tract infections to receive either daily trimethoprim-sulfamethoxazole suspension (as 2 mg of trimethoprim plus 10 mg of sulfamethoxazole per kilogram of body weight) or placebo for 12 months. The primary outcome was microbiologically confirmed symptomatic urinary tract infection. Intention-to-treat analyses were performed with the use of time-to-event data.
RESULTS
: From December 1998 to March 2007, a total of 576 children (of 780 planned) underwent randomization. The median age at entry was 14 months; 64% of the patients were girls, 42% had known vesicoureteral reflux (at least grade III in 53% of these patients), and 71% were enrolled after the first diagnosis of urinary tract infection. During the study, urinary tract infection developed in 36 of 288 patients (13%) in the group receiving trimethoprim-sulfamethoxazole (antibiotic group) and in 55 of 288 patients (19%) in the placebo group (hazard ratio in the antibiotic group, 0.61; 95% confidence interval, 0.40 to 0.93; P = 0.02 by the log-rank test). In the antibiotic group, the reduction in the absolute risk of urinary tract infection (6 percentage points) appeared to be consistent across all subgroups of patients (P≥0.20 for all interactions).
CONCLUSIONS
: Long-term, low-dose trimethoprim-sulfamethoxazole was associated with a decreased number of urinary tract infections in predisposed children. The treatment effect appeared to be consistent but modest across subgroups.
Keyword PRIMARY VESICOURETERAL REFLUX
CONTROLLED-TRIAL
RISK-FACTORS
RENAL SCARS
PREVENTION
PYELONEPHRITIS
ASSOCIATION
MULTICENTER
CHILDHOOD
THERAPY
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Thu, 12 Nov 2009, 21:51:07 EST by Mr Andrew Martlew on behalf of Medicine - Princess Alexandra Hospital