The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), and by inconsistency (variability in results).
A Cochrane review [Abstract] 1 included 16 studies with a total of 2 036 children to assess whether long-term antibiotic prophylaxis is more effective than placebo/no treatment in preventing recurrence of urinary tract infection (UTI) in children. The duration of antibiotic prophylaxis treatment varied from 10 weeks to 12 months. Results for antibiotics compared to placebo or no treatment are shown in table T1.
| Outcome | Relative effect (95% CI) | Risk with placebo | Risk with antibiotic | Participants (studies) |
|---|---|---|---|---|
| Recurrence of symptomatic UTI | RR 0.75(0.28 to 1.98)* | 212 per 1000 | 159 per 1000(59 to 420) | 1 074 (5) |
| Recurrence of symptomatic UTI (studies with adequate allocation concealment) | RR 0.68(0.48 to 0.95) | 161 per 1000 | 110 per 1000(77 to 153) | 914 (2) |
| Recurrence of symptomatic UTI in children with VUR | RR 0.65(0.39 to 1.07) | 180 per 1000 | 117 per 1000(70 to 192) | 371 (2) |
| Recurrence of symptomatic UTI in children without VUR | RR 0.60(0.13 to 2.74)* | 223 per 1000 | 134 per 1000(29 to 611) | 541 (4) |
| Repeat positive urine culture | RR 0.31(0.08 to 1.18)** | 386 per 1000 | 120 per 1000(31 to 455) | 467 (4) |
| All adverse events | RR 2.31(0.03 to 170.67)*** | 24 per 1000 | 56 per 1000(1 to 1000) | 914 (2) |
| Microbial resistance to prophylactic drug | RR 2.40(0.62 to 9.26) | 164 per 1000 | 394 per 1000(102 to 1000) | 118 (2) |
| Statistical heterogeneity: * I2 =94%; ** I2 =91%, *** I2 =88% | ||||
Nitrofurantoin appeared to be the most effective antibiotic; it reduced risk of repeat symptomatic UTI compared to trimethoprim-sulphamethoxazole (RR 0.57, 95% CI 0.35 to 0.92; 2 studies, n=157). Treatment with nitrofurantoin led to a lower risk of a UTI caused by a bacteria resistant to the treatment drug compared to children given trimethoprim-sulphamethoxazole as their prophylactic treatment (RR 0.54, 95% CI 0.31 to 0.92; 2 studies, n=96). Patients receiving nitrofurantoin were twice as likely to experience side effects (nausea, vomiting or stomach ache) than patients receiving trimethoprim (RR 2.18, 95% CI 1.39 to 3.41; 1 study, n=120). The side effects of nitrofurantoin (NNH = 3, 95% CI 2 to 6) were similar to the prophylactic benefit (NNT = 5, 95% CI 3 to 33) compared with trimethoprim.
References
Primary/Secondary Keywords | ||||