Stopping a Kid's UTI from Returning

Urinary tract infections in children with vesicoureteral reflux less likely with antibiotic

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) A urinary tract infection in a child can become very serious if not treated. Those who repeatedly experienced UTIs with a fever may have an underlying condition.

A recent study found that providing preventive antibiotics to children with one underlying condition — called vesicoureteral reflux — reduced their risk of developing another UTI.

The antibiotic actually cut children's risk in half of developing another UTI if they had already had one UTI and vesicoureteral reflux.

Vesicoureteral reflux is a condition in which the urine flows abnormally from the bladder to the upper urinary tract.

"Ask a pediatrician about preventing your child's recurring urinary tract infections."

This study, led by Alejandro Hoberman, MD, of the Children's Hospital of Pittsburgh at the University of Pittsburgh Medical Center, looked at whether using a specific antibiotic might help prevent UTIs in children with vesicoureteral reflux.

The researchers divided 607 children into two groups, with one half receiving an antibiotic called trimethoprim-sulfamethoxazole (brand name Bactrim, Septra, Sulfatrim) and the other half receiving a placebo (fake pill) for two years.

All of the children had been diagnosed with vesicoureteral reflux after having at least one or two UTIs accompanied by a fever or other typical symptoms.

Among the 302 children who received the antibiotic, 39 developed another UTI, compared with 72 out of the 305 children who received the placebo.

Therefore, the use of the antibiotic cut the children's risk of another UTI in half.

Among children whose first UTI had involved a fever, the use of the antibiotic to prevent the recurrence of a UTI reduced the risk even further — to about 60 percent less than the kids who received the placebo.

Among children with dysfunction in their bladder or bowel, the risk of another UTI was about 80 percent lower if they took the antibiotic than if they didn't.

The researchers also compared the existence of renal (kidney) scarring in the two groups but found no major differences.

One potential drawback of using the antibiotic, however, is that other harmful bacteria might develop a resistance to the medication.

During the trial, 87 children experienced a UTI that had been caused by Escerichia coli (E. coli), so the researchers tested samples of the E. coli bacteria.

They found that 63 percent of these children who had received antibiotics were resistant to the trimethoprim-sulfamethoxazole, compared with just 19 percent of the children who did not receive the antibiotic.

Among children with vesicoureteral reflux after urinary tract infection, antimicrobial prophylaxis [preventive antibiotic therapy] was associated with a substantially reduced risk of recurrence but not of renal scarring," wrote the researchers.

This study was published May 4 in the New England Journal of Medicine. The research was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institutes of Health and the National Center for Advancing Translational Sciences.

One author has provided expert testimony related to a legal case involving neonatal hypoglycemia and receives royalties from Up-To-Date and the University of Pittsburgh for development of diagnostic tools.

Other than research grants and/or salary from the National Institutes of Health or a hospital, the other authors reported no possible conflicts of interest.

Review Date: 
May 2, 2014
Last Updated:
May 5, 2014