UroToday.com - A systematic review, performed by Michiel Costers, et al., evaluated the cessation of antibiotic prophylaxis in children with primary vesicoureteral reflux. The main goal of this study was to see whether antibiotics could be safely discontinued in children with reflux and whether prophylaxis was truly effective in the prevention of recurrent UTI’s and renal damage in those patients.

Their findings were that several uncontrolled studies concluded that antibiotic prophylaxis could be discontinued in a subgroup of school-aged patients with low-grade vesicoureteral reflux, normal voiding patterns and kidneys without hydronephrosis or scarring. They found that these patients had to have normal urogenital system anatomy in order for prophylactic antibiotics to be stopped without any adverse effects. They also found that a few recent randomized control trials were suggesting that antibiotic prophylaxis offers no advantage over intermittent antibiotic therapy for treatment of UTI’s in terms of preventing recurrence of UTI’s or new renal damage.

One study, the RIVUR study that is currently under way, is prospectively following patients to be randomized to antibiotic prophylaxis versus no prophylaxis. It will hopefully shed some light on the question of whether antibiotic prophylaxis is truly necessary.