Antimicrobial prophylaxis for children with vesicoureteral reflux
RIVUR Trial Investigators, Alejandro Hoberman, Saul P Greenfield, Tej K Mattoo, Ron Keren, Ranjiv Mathews, Hans G Pohl, Bradley P Kropp, Steven J Skoog, Caleb P Nelson, Marva Moxey-Mims, Russell W Chesney, Myra A Carpenter, J Christopher Austin, Sharon M Bartosh, Louis Bell, Richard Bellah, Sonika Bhatnagar, Eileen D Brewer, Douglas Canning, Myra A Carpenter, Earl Y Cheng, Russell W Chesney, Ross Decter, William Robert DeFoor Jr, Steven G Docimo, Sahar Fathallah-Shaykh, Brian Fisher, Barbara Fivush, Arlene C Gerson, Saul P Greenfield, Robert Hickey, Alejandro Hoberman, Anastasia Ivanova, Ron Keren, Bradley P Kropp, Ranjiv Mathews, Tej K Mattoo, Gordon McLorie, Daniel R McMahon, Marva Moxey-Mims, Milan Nadkarni, Caleb P Nelson, Carrie A Phillipi, Hans G Pohl, Mary Ann Queen, Amy Renwick, H Gil Rushton Jr, Nader Shaikh, Kathy Shaw, Steven J Skoog, Ming-Hsien Wang, Wayne Waz, Lisa Zaoutis, Theoklis Zaoutis, Hongming Zhaung, Stephanie Clevenger, Rachel DeBerardinis, Julie Denlinger, Whitney Drew, Rebecca Duby, Teresa Falk, Allyson J Fried, Beth Garrett, Mary Ann Haralam, Janelle Jennings, Jeremy D Kauffman, Diana Kearney, Kimberly Klipner, Andrea Kuchler, Kathy Lehman, Troy Lubianski, Sabrina Meyer, Theresa Meyer, Ariannah Mirick, Stacey C Moyer, Allison Parker, Lena Peschansky, Lissy Powell, Melissa Reed, Ilina Rosoklija, Bruce M Sprague, Katie Tremont, Lori Triplett, Kamilah Weems, Kirk B Wettengel, Ruthie Youssefi, Jeanne S Chow, Massoud Majd, Michael J Zerin, Harvey A Ziessman, Timothy P Bukowski, William A Primack, Richard W Sutherland, Michael Green, Karen Barbadora, George J Schwartz, Paula S Maier, Ana S Iltis, Virginia Keane, Craig A Peters, Ellen B Roecker, Bruce Slaughenhoupt, Howard Trachtman, RIVUR Trial Investigators, Alejandro Hoberman, Saul P Greenfield, Tej K Mattoo, Ron Keren, Ranjiv Mathews, Hans G Pohl, Bradley P Kropp, Steven J Skoog, Caleb P Nelson, Marva Moxey-Mims, Russell W Chesney, Myra A Carpenter, J Christopher Austin, Sharon M Bartosh, Louis Bell, Richard Bellah, Sonika Bhatnagar, Eileen D Brewer, Douglas Canning, Myra A Carpenter, Earl Y Cheng, Russell W Chesney, Ross Decter, William Robert DeFoor Jr, Steven G Docimo, Sahar Fathallah-Shaykh, Brian Fisher, Barbara Fivush, Arlene C Gerson, Saul P Greenfield, Robert Hickey, Alejandro Hoberman, Anastasia Ivanova, Ron Keren, Bradley P Kropp, Ranjiv Mathews, Tej K Mattoo, Gordon McLorie, Daniel R McMahon, Marva Moxey-Mims, Milan Nadkarni, Caleb P Nelson, Carrie A Phillipi, Hans G Pohl, Mary Ann Queen, Amy Renwick, H Gil Rushton Jr, Nader Shaikh, Kathy Shaw, Steven J Skoog, Ming-Hsien Wang, Wayne Waz, Lisa Zaoutis, Theoklis Zaoutis, Hongming Zhaung, Stephanie Clevenger, Rachel DeBerardinis, Julie Denlinger, Whitney Drew, Rebecca Duby, Teresa Falk, Allyson J Fried, Beth Garrett, Mary Ann Haralam, Janelle Jennings, Jeremy D Kauffman, Diana Kearney, Kimberly Klipner, Andrea Kuchler, Kathy Lehman, Troy Lubianski, Sabrina Meyer, Theresa Meyer, Ariannah Mirick, Stacey C Moyer, Allison Parker, Lena Peschansky, Lissy Powell, Melissa Reed, Ilina Rosoklija, Bruce M Sprague, Katie Tremont, Lori Triplett, Kamilah Weems, Kirk B Wettengel, Ruthie Youssefi, Jeanne S Chow, Massoud Majd, Michael J Zerin, Harvey A Ziessman, Timothy P Bukowski, William A Primack, Richard W Sutherland, Michael Green, Karen Barbadora, George J Schwartz, Paula S Maier, Ana S Iltis, Virginia Keane, Craig A Peters, Ellen B Roecker, Bruce Slaughenhoupt, Howard Trachtman
Abstract
Background: Children with febrile urinary tract infection commonly have vesicoureteral reflux. Because trial results have been limited and inconsistent, the use of antimicrobial prophylaxis to prevent recurrences in children with reflux remains controversial.
Methods: In this 2-year, multisite, randomized, placebo-controlled trial involving 607 children with vesicoureteral reflux that was diagnosed after a first or second febrile or symptomatic urinary tract infection, we evaluated the efficacy of trimethoprim-sulfamethoxazole prophylaxis in preventing recurrences (primary outcome). Secondary outcomes were renal scarring, treatment failure (a composite of recurrences and scarring), and antimicrobial resistance.
Results: Recurrent urinary tract infection developed in 39 of 302 children who received prophylaxis as compared with 72 of 305 children who received placebo (relative risk, 0.55; 95% confidence interval [CI], 0.38 to 0.78). Prophylaxis reduced the risk of recurrences by 50% (hazard ratio, 0.50; 95% CI, 0.34 to 0.74) and was particularly effective in children whose index infection was febrile (hazard ratio, 0.41; 95% CI, 0.26 to 0.64) and in those with baseline bladder and bowel dysfunction (hazard ratio, 0.21; 95% CI, 0.08 to 0.58). The occurrence of renal scarring did not differ significantly between the prophylaxis and placebo groups (11.9% and 10.2%, respectively). Among 87 children with a first recurrence caused by Escherichia coli, the proportion of isolates that were resistant to trimethoprim-sulfamethoxazole was 63% in the prophylaxis group and 19% in the placebo group.
Conclusions: Among children with vesicoureteral reflux after urinary tract infection, antimicrobial prophylaxis was associated with a substantially reduced risk of recurrence but not of renal scarring. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; RIVUR ClinicalTrials.gov number, NCT00405704.).
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Source: PubMed