Kidney Res Clin Pract 2019 Dec; 38(4): 441-454  
Current status of long-term antibiotic prophylaxis for urinary tract infections in children: An antibiotic stewardship challenge
Sarah S. Alsubaie1 , Mazin A. Barry2
1Pediatric Infectious Diseases Unit, Department of Pediatrics, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2Infectious Diseases Unit, Department of Internal Medicine, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
Correspondence to: Sarah S. Alsubaie
Pediatric Infectious Diseases Unit, Department of Pediatrics, King Saud University Medical City, College of Medicine, King Saud University, PO Box 2925, Riyadh 11461, Saudi Arabia. E-mail: salsubaie@ksu.edu.sa

Edited by Eun Hui Bae, Chonnam National University, Gwangju, Republic of Korea
Received: September 4, 2019; Revised: October 15, 2019; Accepted: October 21, 2019; Published online: December 31, 2019.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Recurrent urinary tract infections (UTIs) in children are associated with development of pyelonephritis and renal scarring. Traditionally, continuous antibiotic prophylaxis (CAP) has been used to prevent recurrent UTI. Recent studies have challenged the efficacy of CAP for preventing renal scarring and have raised concerns about inducing bacterial resistance. This review focuses on studies published between January 2000 and April 2019 and evaluates the use of CAP in children for avoiding recurrent UTIs and renal scarring. A systematic literature search was carried out using the following search terms and related medical subject headings in the MEDLINE electronic database: ‘urinary tract infection’, ‘antimicrobial/antibiotic prophylaxis’, and ‘children/pediatrics’. Randomized clinical trials (RCTs), original research articles, guidelines, systematic reviews, and meta-analyses describing antibiotic prophylaxis for UTIs were included. A total of 34 RCTs, 9 systematic reviews, and 3 guidelines describing antibiotic prophylaxis were included in this review. The efficacy of CAP for preventing recurrent UTI remains unclear due to non-generalizability of results obtained from suboptimally designed clinical trials. CAP has not been proven as beneficial for preventing new renal scarring in children. Additionally, CAP is associated with increased risk of multidrug resistant infections in children. No conclusive evidence can be drawn from the available clinical data to support routine use of CAP for prevention of renal scarring. Accumulation of evidence from additional well designed studies may result in different conclusions in the future. It is important to identify specific risks for recurrent UTI and ensuing renal injury to ensure more judicious use of CAP.
Keywords: Anti-bacterial agents, Antibiotic prophylaxis, Child, Pediatrics, Urinary tract infections


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