Antibiotic prophylaxis in children with relapsing urinary tract infections: Review

Recurrent urinary tract infections (UTIs) are observed in 30-50% of childre n after the first UTI. Of these, approximately 90% occur within 3 months of the initial episode. The basic aim of antibiotic prophylaxis in children w ith malformative uropathy and/or recurrent UTIs, is to reduce the frequency of UTIs. The bacteria most frequently responsible for UTI are Gram-negativ e organisms, with Escherichia coli accounting for 80% of urinary tract path ogens. In children with recurrent UTIs and in those treated with antibiotic prophylaxis there is a greater incidence of UTI due to Proteus spp., Klebs iella spp. and Enterobacter spp., whereas Pseudomonas spp., Serratia spp. a nd Candida spp. are more frequent in children with urogenital abnormalities and/or undergoing invasive instrumental investigations. Several factors ar e involved in the pathogenesis of UTI, the main ones being circumcision, pe riurethral flora, micturition disorders, bowel disorders, local factors and hygienic measures. Several factors facilitate UTI relapse: malformative ur opathies, particularly of the obstructive type; vesico-ureteric reflux (VUR ); previous repeated episodes of cystitis and/or pyelonephritis (3 or more episodes a year), even in the absence of urinary tract abnormalities; a fre quently catheterized neurogenic bladder; kidney transplant. The precise mec hanism of action of low-dose antibiotics is not yet fully known. The charac teristics of the ideal prophylactic agent are presented in this review, as well as indications, dosages, side effects, clinical data of all molecules. While inappropriate use of antibiotic prophylaxis encourages the emergence of microbial resistance, its proper use may be of great value in clinical practice, by reducing the frequency and clinical expression of UTIs and, in some cases such as VUR, significantly helping to resolve the underlying pa thology.