Antibiotic prophylaxis in vesicoureteral reflux: A paradigm shift

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Authors: J. Banerji and J. Singh
Date: January-March 2009
From: Indian Journal of Urology(Vol. 25, Issue 1)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Report
Length: 820 words

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Byline: J. Banerji, J. Singh

Summary

In this prospective trial, Pennesi et al,[sup] [1] randomized 100 children with vesicoureteral reflux (VUR) into a treatment arm, which received two years of oral sulfamethoxazole/trimethoprim and a control arm that did not receive any chemoprophylaxis. Based on prior trials, a sample size of 48 was required for a 30% absolute risk difference. Analysis was done on an intention to treat basis. Children between the age of 1 day and 30 months at first episode of pyelonephritis were included. As Grade 1 would spontaneously resolve in the majority, and grade five has a high probability of being associated with renal dysplasia, only children who had grades 2-4 VUR were included. Voiding cystourethrography was performed in all, two months following the acute pyelonephritis. Renal ultrasound and DMSA scan were performed at six months. Although antibiotic prophylaxis was discontinued at two years in the intervention group, all subjects were followed up for a total period of four years. The results were quite an eye opener. Contrary to prior understanding, in the chemoprophylaxis group, there was a slightly higher risk, though not statistically significant, for developing pyelonephritis (RR 1.42 in the first year and 1.25 in the second year). 36% children in...

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Gale Document Number: GALE|A194383641