Prophylaxis After First Febrile Urinary Tract Infection in Children? A Multicenter, Randomized, Controlled, Noninferiority Trial

Montini, Giovanni; Rigon, Laura; Zucchetta, Pietro; Fregonese, Federica; Toffolo, Antonella; Gobber, Daniela; Cecchin, Diego; Pavanello, Luigi; Molinari, Pier Paolo; Maschio, Francesca; Zanchetta, Sergio; Cassar, Walburga; Casadio, Luca; Crivellaro, Carlo; Fortunati, Paolo; Corsini, Andrea; Calderan, Alessandro; Comacchio, S.; Tommasi, Luca; Hewitt, Ian K.; Dalt, Liviana Da; Zacchello, Graziella; Dall’Amico, Roberto

doi:10.1542/peds.2007-3770

Cited by 316 publications

(215 citation statements)

References 18 publications

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“…These results are similar to those reported in other recent studies that evaluated the role of antimicrobial prophylaxis in reducing the risk of renal scarring (25)(26)(27)(28)(29). However, these results should not be interpreted as conclusive evidence against the role of antimicrobial prophylaxis in preventing renal scarring.…”

Section: Discussionsupporting

confidence: 86%

“…The proportion of children with any renal scars in the RIVUR trial (10%) was higher than the 6% reported by Garin et al (25) and lower than the 30%-63% reported in other recent studies (26)(27)(28)(29). We believe that the low incidence of renal scarring in our study may be related to the exclusion of children with more than two febrile or symptomatic UTIs, careful monitoring for UTI recurrence, prompt intervention during the study period, generally younger study cohort, and the exclusion of children with grade 5 VUR in comparison to the study by Craig et al (28).…”

Section: Discussionmentioning

confidence: 52%

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Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Mattoo¹,

Chesney²,

Greenfield³

et al. 2016

Clinical Journal of the American Society of Nephrology

105

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Background and objectives The main objectives of the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial were to evaluate the role of antimicrobial prophylaxis in the prevention of recurrent urinary tract infection (UTI) and renal scarring in children with vesicoureteral reflux (VUR). We present a comprehensive evaluation of renal scarring outcomes in RIVUR trial participants.Design, setting, participants, & measurements This multicenter, randomized, placebo-controlled trial enrolled 607 children aged 2-71 months with grade 1-4 VUR diagnosed after a first or second febrile or symptomatic UTI. Study participants received trimethoprim-sulfamethoxazole or placebo and were followed for 2 years. Renal scarring was evaluated by baseline and follow-up 99m technetium dimercaptosuccinic acid (DMSA) renal scans that were reviewed independently by two blinded reference radiologists.Results At the end of the study, 58 (10%) of 599 children and 63 (5%) of 1197 renal units had renal scarring. New renal scarring did not differ between the prophylaxis and placebo groups (6% versus 7%, respectively). Children with renal scarring were significantly older (median age, 26 versus 11 months; P=0.01), had a second UTI before enrollment (odds ratio [OR], 2.85; 95% confidence interval [95% CI], 1.38 to 5.92), were more likely to be Hispanic (OR, 2.22; 95% CI, 1.13 to 4.34), and had higher grades of VUR (OR, 2.79; 95% CI, 1.56 to 5.0). The proportion of new scars in renal units with grade 4 VUR was significantly higher than in units with no VUR (OR, 24.2; 95% CI, 6.4 to 91.2).Conclusions Significantly more renal scarring was seen in relatively older children and in those with a second episode of febrile or symptomatic UTI before randomization. Preexisting and new renal scars occurred significantly more in renal units with grade 4 VUR than in those with low-grade or no VUR. Antimicrobial prophylaxis did not decrease the risk of renal scarring.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 52%

Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Mattoo¹,

Chesney²,

Greenfield³

et al. 2016

Clinical Journal of the American Society of Nephrology

105

View full text Add to dashboard Cite

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“…The efficacy of prophylactic antibiotics in preventing UTIs and further renal scarring has been tested in a number of recent studies [8][9][10][11][12] which were summarised in a metaanalysis in American guidelines [1]. This meta-analyse could not show any benefit from antibiotic prophylaxis over placebo treatment-irrespective of grade of VUR.…”

Section: Reasons For Changesmentioning

confidence: 99%

Does the ureteric jet Doppler waveform have a role in detecting vesicoureteric reflux?

Tullus

2013

Pediatr Nephrol

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Data reported in this issue of Pediatric Nephrology suggest that the ureteric jet Doppler waveform can predict the occurrence of vesicoureteric reflux (VUR). Many different methods are currently used to detect VUR, including traditional X-ray micturating cystourethrogram, indirect and direct nuclear imaging and contrast enhanced ultrasonography. These methods are invasive, do have some radiation burden and are also quite uncomfortable to paediatric patients. This relatively new non-invasive method is therefore of interest, but its efficacy needs to be confirmed in further studies and, in particular, in babies and infants before it can possibly be considered as a good method to provide clinical information on VUR. Once such studies have been performed, this method may also prove to be a useful approach to obtain modern knowledge on the occurrence of VUR in healthy children.

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“…This is true for studies such as those on inflammatory markers and the rate of vesicoureteric reflux. Six studies have recently been published on antimicrobial prophylaxis for the prevention of recurrent UTI in infants and children with vesicoureteric reflux [19][20][21][22][23][24]. Three of these studies used mainly suprapubic aspiration or bladder catherisation [19][20][21], while the others relied on bag collection of urine [22][23][24].…”

Section: Consequences Of the Difficult Diagnosis Of Febrile Utimentioning

confidence: 99%

Difficulties in diagnosing urinary tract infections in small children

Tullus

2011

Pediatr Nephrol

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Urinary tract infections (UTIs) in children appear to be simple and straightforward matters, but there is as yet no consensus on UTIs in this patient group, and it remains one of the most -if not the most -controversial fields in paediatric medicine. Controversy and the lack of consensus can be found in many areas, including the diagnosis and management of UTIs in paediatric patients. Consequently, children with a UTI are investigated and treated quite differently in different parts of the world and also within different parts of the same country. One factor contributing to the current situation is the unexpected difficulty in diagnosing a UTI in children. This difficulty has implications not only for clinical work but also for scientific studies. Substantial over-and under-diagnosing can result from practical difficulties in at least three areas, including problems with collecting urine samples, in interpreting bacterial numbers correctly, and in confusing infantile asymptomatic bacteriuria and a true symptomatic febrile UTI. In this review, these problems will be discussed in detail as well as the implications they have had on clinical practice and research on UTIs.

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Prophylaxis After First Febrile Urinary Tract Infection in Children? A Multicenter, Randomized, Controlled, Noninferiority Trial

Abstract: For children with or without primary nonsevere reflux, prophylaxis does not reduce the rate of recurrent febrile urinary tract infections after the first episode.

Cited by 316 publications

References 18 publications

Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Does the ureteric jet Doppler waveform have a role in detecting vesicoureteric reflux?

Difficulties in diagnosing urinary tract infections in small children

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