Antibiotics May Not Prevent Urinary Tract Infections From Recurring In Children And May Cause Resistance

Prescribing antibiotics to prevent urinary tract infection from recurring in children under age 6 appears to have no effect and may increase the risk of drug resistance, according to a new study supported by HHS' Agency for Healthcare Research and Quality and published in the July 11, 2007 issue of JAMA. Urinary tract infections are a common problem in children; it is estimated that 70,000 to 180,000 children born in a given year will have this type of infection by the age of 6. Urinary tract infections may cause obvious symptoms in older children, such as frequent or painful urination, but these symptoms are harder to detect in infants and younger children. The American Academy of Pediatrics currently recommends daily preventive antibiotics if a child has vesicoureteral reflux, a condition in which urine flows backward from the bladder towards the kidneys to varying degrees, ranging from 1 (mild) to 5 (severe). It has been postulated that this reflux increases the risk of repeated urinary tract infections and infection-related scarring of the kidneys. However, the investigation by the AHRQ-funded University of Pennsylvania Center for Education and Research on Therapeutics found that the majority of the children in the study had milder grades of vesicoureteral reflux and these were not associated with increased risk of recurrent urinary tract infection. The researchers, who were led by Patrick Conway, M.D., also found no association between giving antibiotics to prevent an infection from recurring and the risk of recurrent urinary tract infection. But they did find significant increased risk of resistant infection in those children who were exposed to preventive antibiotics. The patients in the study were from a Children's Hospital of Philadelphia-supported network of 27 primary care pediatric practices spanning three states. Of the approximately 75,000 children ranging from infancy through the age of 6 who were in the network from July 2001 to May 2006, 611 had a first urinary tract infection and 83 had a recurrent infection. Sixty-one percent of the cases of recurrent urinary tract infection were caused by a pathogen with antibiotic resistance, including Escherichia coli and Enterococcus. The researchers also found that a child's age and race may play a role in the risk of urinary tract infection recurring and being resistant to antibiotics. Children between 2 and 6 years of age had a higher risk of recurrent urinary tract infection in comparison to children less than 2 years of age. Furthermore, although the non-white children in the study were less likely than white children to have recurrent urinary tract infection, they had a greater risk of having an antibiotic-resistant recurrent infection. According to Dr. Conway, it would be prudent for physicians to discuss the potential risks and unclear benefits of giving children antibiotics tp prevent recurrent infections with parents, who can then decide whether to start daily preventive antibiotics or closely monitor their child with their physician's guidance. Dr. Conway and his team say that this is the first study to estimate the effectiveness of preventive antibiotics in a large primary care pediatric population and the first to determine risk factors for the disease in such a large group.