Investig Clin Urol.  2017 Jun;58(Suppl 1):S32-S37. 10.4111/icu.2017.58.S1.S32.

Vesicoureteral reflux and continuous prophylactic antibiotics

• Lee T
• Park JM

• KMID: 2379893
• DOI: http://doi.org/10.4111/icu.2017.58.S1.S32

Abstract

Vesicoureteral reflux (VUR) management must be tailored based on the risk for further infections and renal scarring, gender, likelihood of spontaneous resolution, and parental preferences. Because we now understand that sterile VUR is benign and most reflux spontaneously resolves over time, the initial approach in majority of children is non-surgical with continuous antibiotic prophylaxis (CAP) and correction of bladder and bowel dysfunction. Despite increasing utilization of CAP over the past four decades, the efficacy of antibiotic prophylaxis has been questioned due to conflicting results of studies plagued with design flaws and inadequate subject sample size. The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial, which was designed to address many of the limitations from previous studies, provided much needed answers. In this review, we sought to describe the controversy surrounding VUR management, highlight the results of RIVUR trial, and discuss how the RIVUR findings impact our understanding of CAP in the management of VUR.

Keyword

Antibiotic prophylaxis; Pyelonephritis; Urinary tract infection; Vesicoureteral reflux

MeSH Terms

Anti-Bacterial Agents*
Antibiotic Prophylaxis
Child
Cicatrix
Humans
Parents
Pyelonephritis
Sample Size
Urinary Bladder
Urinary Tract Infections
Vesico-Ureteral Reflux*
Anti-Bacterial Agents

Figure

• 

  Fig. 1 VUR resolution nomogram tables. Predicted rates of cumulative annual spontaneous resolution of primary VUR and 95% confidence intervals tabularized and expressed as percentage of cases. Resolution rates are shown for boys with unilateral or bilateral reflux and girls with unilateral reflux (A), and for girls with bilateral reflux (B). Adapted from Estrada et al. J Urol 2009;182:1535-41 [8], with permission of Elsevier Inc.

• 

  Fig. 2 Continuous antibiotic prophylaxis (trimethoprim-sulfamethoxazole) versus placebo, time to symptomatic urinary tract infection in Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial. UTI, urinary tract infection. Adapted from RIVUR Trial Investigators., et al. N Engl J Med 2014;370:2367-76 [21], with permission of Massachusetts Medical Society.

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