학술논문
Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group
Document Type
article
Author
Giovanni Autore; Luca Bernardi; Filippo Ghidini; Claudio La Scola; Alberto Berardi; Giacomo Biasucci; Federico Marchetti; Andrea Pasini; Maria Elena Capra; Claudia Castellini; Vera Cioni; Sante Cantatore; Andrea Cella; Francesca Cusenza; Alessandro De Fanti; Elisa Della Casa Muttini; Margherita Di Costanzo; Alessandra Dozza; Claudia Gatti; Cristina Malaventura; Luca Pierantoni; Giovanni Parente; Gabriella Pelusi; Serafina Perrone; Laura Serra; Francesco Torcetta; Enrico Valletta; Gianluca Vergine; Francesco Antodaro; Andrea Bergomi; Jennifer Chiarlolanza; Laura Leoni; Franco Mazzini; Roberto Sacchetti; Agnese Suppiej; Lorenzo Iughetti; Andrea Pession; Mario Lima; Susanna Esposito; The UTI-Ped-ER Study Group
Source
Antibiotics, Vol 12, Iss 6, p 1040 (2023)
Subject
Language
English
ISSN
2079-6382
Abstract
Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. Methods: A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results: The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended. Conclusions: Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk.