ROLE OF ANTIBIOTIC PROPHYLAXIS IN THE MANAGEMENT OF VESICOURETERAL REFLUX
Authors:
H. G. Pohl
Authors‘ workplace:
Children's National Medical Center, George Washington University School of Medicine, Washington D. C.
Published in:
Urol List 2012; 10(1): 42-46
Overview
Vesicoureteral reflux (VUR) had been considered the primary risk factor predisposing children to acquired renal cortical scarring and, based on this association, the historical management of VUR was primarily surgical. The recognition that urinary tract infection (UTI), specifically infection of the renal parenchyma (acute pyelonephritis, APN), could result in renal scarring, both in the presence of VUR as well as in its absence, changed the paradigm of VUR management such that most patients initially receive a sub-therapeutic dose of antibiotic daily in order to prevent UTI, with surgical management reserved when medical management is deemed unsuccessful. It is not disputed that in general the non-operative approach to VUR is rational; however, not all children benefit from the recommendation to remain on prophylaxis until VUR resolves completely by virtue of recurrent UTI (rUTI) or poor compliance, both of which may result in recurrent UTI with the risk of renal scarring. In other circumstances, the child with VUR may be at low risk of recurrent infection or renal scarring, thus obviating one goal of prophylaxis. Thus, the role of continuous prophylaxis in VUR management may not be appropriate for every child. We will consider the rationale for antibiotic prophylaxis in light of contemporary data regarding the natural history of VUR, UTI and renal scarring, as well as the efficacy of various treatment strategies.
Key words:
vesicoureteral reflux, antibiotic prophylaxis, UTI, renal scarring
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