Antibiotic prophylaxis for children at risk of developing urinary tract infection: a systematic review

Background:  Antibiotic prophylaxis in children who have had urinary tract infection (UTI) to prevent further infection is a common practice. The aim of this study is to reduce the development of further renal scarring by the prevention of recurrent acute pyelonephritis.
Methods:  A systematic review of randomized controlled trials assessing effectiveness of antibiotic prophylaxis in children who have recovered from a symptomatic UTI and children in whom vesico-ureteric reflux has been identified independent of a history of acute UTI was carried out by systematic search in Medline, EMBASE, the Cochrane Library and CINAHL using keywords and thesaurus terms. Identified trials were independently appraised by two researchers. Data were extracted and synthesized in meta-analyses.
Results:  A total of 677 children in eight trials were included in the analyses. There was no evidence of difference on meta-analysis of all the included studies, or any of the four subgroups, between the intervention and control groups in recurrence of symptomatic UTI [four trials, RR 0.96 (95% CI: 0.69–1.32]) and incidence of new or progressive renal scarring [four trials, overall RR 1.15 (95% CI: 0.75–1.78)].
Conclusion:  Given the lack of evidence on positive benefit of using prophylactic antibiotics for children at risk of developing UTI, routine use of antibiotics for these children is not recommended.