- In children with repeated symptomatic urinary tract infection (UTI), long-term, low-dose antibiotics show small benefit.
- This course should be reserved for patients at high risk, such as infants or children with renal abnormalities, say the authors of this Cochrane review.
Why this matters
- The debate continues over the best use, if any, of low-dose, long-term antibiotics in pediatric UTI.
- This review updates a 2011 version , leaving conclusions unchanged.
- Bias risk was high in at least 1 domain in 15 of the 16 included studies.
- Most bias risk was unclear because of poorly reported methodology.
- Some risk reduction seen with antibiotics vs placebo/no treatment, but the estimates are uncertain, and the CI indicates low precision:
- Risk ratio: 0.75 (95% CI, 0.28-1.98).
- When only studies blinded to randomization were included, the risk ratio was similar at 0.68, with a more convincing CI (95% CI, 0.48-0.95).
- Adverse event findings were inconsistent.
- Some findings suggested role of prophylaxis in increased risk for resistant bacteria.
- 16 studies included, with 2036 children.
- Funding: The Children's Hospital Fund Clinical Research Grant, Australia; National Health and Medical Research Council, Australia; Australian Kidney Foundation.
- Uncertain bias, limitations of included studies.