Objectives: To assess the efficacy of antibiotic prophylaxis for prevention of urinary infections and renal parenchymal damage in children with primary vesicoureteral reflux (VUR).
Methods/results: A search based on MEDLINE and The Cochrane Library was performed selecting those clinical trials and meta-analysis which compared antibiotic prophylaxis (either continuous or intermittent) and placebo or no treatment at all in children with primary VUR. Three systematic reviews were chosen for assessing the efficacy of prophylaxis of urinary infections including trials with a predominant paediatric population without known VUR. Results showed that the use of antibiotics decreased the risk of urinary infection. The quality of the trials was, however, insufficient and therefore of questionable results. We also selected two randomized controlled trials in children with reflux: one had limited information as the degree of reflux was not stated; the second assessed the results in a population of 113 children with VUR grade I to III (55 receiving prophylaxis and 58 not) following acute pyelonephritis. There were no differences with regard to the risk of urinary infection or the risk of renal parenchymal damage.
Conclusions: There is not enough evidence supporting generalized use of antibiotics to prevent urinary infections. No benefit in prophylaxis has been proven for VUR grades I to III. There is no data for high grade VUR. It will be necessary to perform more trials in order to establish more accurate recommendations on prevention of urinary infections in the presence of VUR.