The quality of evidence is downgraded by study limitations (lackf of/unclear allocation concealment and blinding), and by inconsistency (unexplained variability in results).
A Cochrane review [Abstract] 1 included 34 studies with a total of 4 001 children with vesicoureteric reflux (VUR). Interventions included long-term low-dose antibiotics, surgical reimplantation of ureters, endoscopic injection treatment, probiotics, cranberry products, circumcision, and oxybutynin, and were used alone and in combinations.
Long-term low-dose antibiotic prophylaxis compared to no treatment/placebo did not significantly reduce repeat symptomatic urinary tract infections (UTI) (RR 0.77, 95% CI 0.54 to 1.09; 9 studies, n=1 667; statistical heterogeneity I2 =59%) or febrile UTI (RR 0.83, 95% CI 0.56 to 1.21; 9 studies, n=1 667; I2 =51%) at 1 to 2 years, although the pooled estimates favoured antibiotic treatment. At 1 to 3 years, antibiotic prophylaxis did not reduce the risk of new or progressive renal damage on dimercaptosuccinic acid (DMSA) scan (RR 0.73, 95% CI 0.33 to 1.61; 8 studies, n=1 503). Adverse events were reported in 4 studies (n=1 056) and no difference between groups was observed (RR 0.94, 95% CI 0.81 to 1.08), but antibiotics increased the likelihood of bacterial drug resistance threefold (RR 2.97, 95% CI 1.54 to 5.74; 187 UTIs).
Surgical reimplantation of ureters plus antibiotic treatment compared to antibiotics alone reduced the risk of repeat febrile UTI by 57% (RR 0.43, 95% CI 0.27 to 0.70; 2 studies, n=429). There was little or no difference in the risk of new kidney defects detected using intravenous pyelogram at 4 to 5 years (RR 1.09, 95% CI 0.79 to 1.49; 4 studies, n=572). There was no difference in the risk of febrile UTI when endoscopic injection was compared to antibiotics alone (RR 0.74, 95% CI 0.31 to 1.78; 3 studies, n=254; I2 =58%).
There was no difference between probiotic treatment and antibiotics in risk of repeat symptomatic UTI (RR 0.82 95% CI 0.56 to 1.21; 2 studies, n=248).
Primary/Secondary Keywords