Antibiotics for the prevention of urinary tract infection in children: A systematic review of randomized controlled trials

Objective: The objective was to evaluate the effectiveness of low-dose, lon g-term antibiotics for the prevention of symptomatic urinary tract infectio n (UTI) in children. Design: This was a systematic review of randomized controlled trials with a random effects model meta-analysis. Participants: Five trials involving 463 children were performed. Results: Three trials (n = 392) evaluated the effectiveness of long treatme nt courses of antibiotics (2 to 6 months) for children with acute UTI to pr event subsequent, off-treatment infection. Only 2 trials (n = 71) evaluated the effectiveness of long-term, low-dose antibiotics to prevent on-treatme nt UTI. Very few of the children enrolled in the trials were boys, had abno rmal renal tracts, or were infants. The trial quality was poor, with a lack of blinding, and unstated UTI definitions were almost universal. Long-tel- m antibiotic administration reduced the risk of UTI with treatment (relativ e risk 0.31, 95% confidence limits 0.10 to 1.00), but there was significant heterogeneity (Q = 13.45, P < .01), and there was no sustained benefit onc e antibiotics had ceased (relative risk 0.79, 0.61 to 1.02). Conclusions: Methodologic and applicability problems with published trials mean that there is considerable uncertainty about whether long-ter m, low-d ose antibiotic administration prevents UTI in children. Well-designed, rand omized, placebo-controlled trials are still required to evaluate this commo nly used intervention.