Antibiotic Prophylaxis in Infants with Grade III, IV, or V Vesicoureteral Reflux
RCT (n=292 age 1-5 months with no previous UTI) found continuous antibiotic prophylaxis for 2 years reduced the occurrence of a first UTI vs no treatment (31 [21.2%] vs 52 [35.6%] patients, HR 0.55, 95%CI 0.35-0.86, NNT = 7). Serious adverse events were similar across the groups.
Source:
New England Journal of Medicine
SPS commentary:
Pseudomonas species, other non–Escherichia coli organisms, and antibiotic resistance were more common in UTI isolates obtained from participants in the prophylaxis group than in isolates obtained from those in the untreated group.
A related editorial notes the trial was neither blinded nor placebo-controlled, and four different antibiotic options were used for continuous antibiotic prophylaxis. Little was reported about protocol adherence or quality-control measures across the 39 centres in various countries with different health care systems. Despite these limitations, it suggests the trial adds valuable data, showing that continuous antibiotic prophylaxis significantly reduces the risk of UTI, although not among all children considered as a whole, and at the expense of increased antimicrobial resistance. However, it points out interpretation of trial results in terms of numbers needed to treat is not helpful, even though it is a valuable metric for treatment effectiveness for the whole population, as it does not help calculate the individual risk–benefit ratio and cannot be the sole basis for clinical decision making. It highlights the key takeaway message from this and other trials is that continuous antibiotic prophylaxis should be used judiciously.