Antibiotics Won't Prevent Urinary Tract Infections in Kids: Study

TUESDAY, July 10 (HealthDay News) -- Giving antibiotics to prevent recurrent urinary tract infections in small children won't help and may even hurt, a new study finds.

Reporting in the July 11 issue of theJournal of the American Medical Association, researchers say the use of antibiotics as prevention boosts risks for drug resistance while doing nothing to shield kids from future urinary tract infections (UTIs).

The findings are good news, because it will probably end up changing practice for the better, some pediatricians said.

"It's great news for us, because a lot of kids are on antibiotics for a long time, and they can get resistance, which has been a growing problem," said Dr. Fabienne Wheeler, a pediatrician with Northern Westchester Hospital Center in Mount Kisco, N.Y. "I would think this would change practice pretty soon," she said.

An estimated 3 percent to 7 percent of girls younger than 6, and 1 percent to 2 percent of boys in that age group, experience a UTI by the age of 6, for a total of up to 180,000 young U.S. children each year.

As part of diagnosis and treatment, the American Academy of Pediatrics recommends conducting an imaging study to evaluate the presence and severity or grade of vesicoureteral reflux (VUR, a backflow of urine from the bladder into the ureter). Some 30 percent to 40 percent of children with UTI also have this condition.

If the child does have VUR, the guidelines recommend giving daily antibiotic treatment in an attempt to prevent future UTIs.

According to the authors of this study, however, there is limited evidence supporting VUR as a risk factor for recurrent UTIs or evaluating the risks and benefits of antibiotic treatment. And there could be harm, in the form of antibiotic resistance, associated with the practice.

The authors looked at 611 children under the age of 6 who had had a first urinary tract infection and 83 children who had suffered from recurrent UTIs.

Several factors were associated with a heightened risk of recurrent UTI including being white (nearly double the risk), being aged 3 to 4 (almost triple the risk), being age 4 to 5 (nearly 2.5 times the risk), and having a grade 4 to 5 VUR (over four times the risk). VUR severity is measured on a scale of 1 to 5, with 5 being the most severe.

Gender, less severe VUR and exposure to other antibiotics werenotassociated with a risk of recurrence.

Preventive antimicrobial therapy did not lower a child's risk of recurrent UTI, the researchers found. However, prior use of antibiotics to prevent infection did boost the likelihood of developing a drug-resistant infection by nearly 7.5 times. Indeed, 61 percent of recurrent urinary tract infections were caused by a pathogen with antibiotic resistance, the researchers pointed out.