Cessation of prophylactic antibiotics for managing persistent vesicoureteral reflux

Purpose: We reviewed our experience with patients with vesicoureteral reflu x treated off prophylactic antibiotics. Materials and Methods: We retrospectively reviewed the records of patients with vesicoureteral reflux treated off prophylactic antibiotics, noting the intervals on and off antibiotics, urinary tract infection, signs and sympt oms associated with urinary tract infection, and renal ultrasound and dimer capto-succinic acid scan findings. Results: We identified 196 patients with vesicoureteral reflux treated off prophylactic antibiotics, including 122 who were infection-free while on an d 124 who had no urinary tract infection while off prophylactic antibiotics . The infection rate on and off prophylactics was 0.29 and 0.24 urinary tra ct infections per patient per year, respectively. New scars were identified in 5 patients while on prophylactics and in 7 after antibiotics were disco ntinued. Comparing different subgroups off prophylactic antibiotics showed that children who presented with scarring had statistically fewer new scars than those with normal initial dimercapto-succinic acid imaging (p <0.043) . Girls had significantly more urinary tract infections than boys while off prophylactics (p <0.01) despite the older age at antibiotic cessation. How ever, after infection occurred while off prophylactic antibiotics, new rena l scars developed at about the same rate in boys and girls. Because most pa tients did not have a urinary tract infection while off prophylactic antibi otics, new renal scars developed in only 2.2% of all boys and 4% of all gir ls. Conclusions: Our findings imply that discontinuing antibiotics is reasonabl e and safe in patients in whom vesicoureteral reflux fails to resolve.