Antibiotics Won't Prevent Urinary Tract Infections in Kids: Study

In fact, preventive use could spur drug resistance, researchers say

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HealthDay Reporter

TUESDAY, July 10, 2007 (HealthDay News) -- Giving antibiotics to prevent recurrent urinary tract infections in small children won't help and may even hurt, a new study finds.

Reporting in the July 11 issue of the Journal of the American Medical Association, researchers say the use of antibiotics as prevention boosts risks for drug resistance while doing nothing to shield kids from future urinary tract infections (UTIs).

The findings are good news, because it will probably end up changing practice for the better, some pediatricians said.

"It's great news for us, because a lot of kids are on antibiotics for a long time, and they can get resistance, which has been a growing problem," said Dr. Fabienne Wheeler, a pediatrician with Northern Westchester Hospital Center in Mount Kisco, N.Y. "I would think this would change practice pretty soon," she said.

An estimated 3 percent to 7 percent of girls younger than 6, and 1 percent to 2 percent of boys in that age group, experience a UTI by the age of 6, for a total of up to 180,000 young U.S. children each year.

As part of diagnosis and treatment, the American Academy of Pediatrics recommends conducting an imaging study to evaluate the presence and severity or grade of vesicoureteral reflux (VUR, a backflow of urine from the bladder into the ureter). Some 30 percent to 40 percent of children with UTI also have this condition.

If the child does have VUR, the guidelines recommend giving daily antibiotic treatment in an attempt to prevent future UTIs.

According to the authors of this study, however, there is limited evidence supporting VUR as a risk factor for recurrent UTIs or evaluating the risks and benefits of antibiotic treatment. And there could be harm, in the form of antibiotic resistance, associated with the practice.

The authors looked at 611 children under the age of 6 who had had a first urinary tract infection and 83 children who had suffered from recurrent UTIs.

Several factors were associated with a heightened risk of recurrent UTI including being white (nearly double the risk), being aged 3 to 4 (almost triple the risk), being age 4 to 5 (nearly 2.5 times the risk), and having a grade 4 to 5 VUR (over four times the risk). VUR severity is measured on a scale of 1 to 5, with 5 being the most severe.

Gender, less severe VUR and exposure to other antibiotics were not associated with a risk of recurrence.

Preventive antimicrobial therapy did not lower a child's risk of recurrent UTI, the researchers found. However, prior use of antibiotics to prevent infection did boost the likelihood of developing a drug-resistant infection by nearly 7.5 times. Indeed, 61 percent of recurrent urinary tract infections were caused by a pathogen with antibiotic resistance, the researchers pointed out.

Although non-white children were less likely than Caucasian children to have recurrent infections, they ran a greater risk of developing an antibiotic-resistant recurrent infection, the researchers found.

Based on these findings, kids who suffer from recurrent UTIs will likely be treated "as the infections come up," Wheeler said.

According to the authors, this study is the first to look at the effectiveness of preventive antibiotics in a large primary care pediatric population and the first to determine risk factors in such a group.

"For individual physicians and patients, we would suggest that they consider discussing the unclear benefits and risks of daily antibiotics to prevent UTIs and let families decide whether to give daily antibiotics or just monitor for symptoms," said study lead author Dr. Patrick H. Conway, an assistant professor of pediatrics at Cincinnati Children's Hospital, who was a Robert Wood Johnson clinical scholar at the University of Pennsylvania at the time the study was done.

"We hope that the American Academy of Pediatrics will consider this large study in a pediatric care population in potentially revising their guidelines," Conway said. "We think it's reasonable to not follow the guidelines and explain to parents the potential risks and benefits of prophylaxis and [possibly] not start daily antibiotics."

"It was an impressive increased risk of resistance, 7.5 times if exposed to daily antibiotics," Conway noted.

More information

Visit the National Kidney and Urologic Diseases Information Clearinghouse for more information on urinary tract infections.

SOURCES: Fabienne Wheeler, M.D., pediatrician, Northern Westchester Hospital, Mt. Kisco, N.Y.; Patrick H. Conway, M.D., assistant professor of pediatrics, Cincinnati Children's Hospital; July 11, 2007, Journal of the American Medical Association

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