Continuous antibiotic treatment does not prevent pyelonephritis or renal scars in children with vesicoureteral reflux (VUR), according to a report in the June issue of Pediatrics.

Continuous antibiotic treatment does not prevent pyelonephritis or renal scars in children with vesicoureteral reflux (VUR), according to a report in the June issue of Pediatrics.

"There is no doubt about the ineffectiveness of antibiotic prophylaxis in children with VUR," Dr. Laura Travan told Reuters Health. "Even searching for VUR at the very first infection in children with negative ultrasounds is questionable."

Dr. Travan from the Institute of Child Health IRCCS Burlo Garofolo, Trieste, Italy and colleagues assessed the effectiveness of antibiotic prophylaxis with trimethoprim-sulfamethoxazole vs. no prophylaxis in preventing pyelonephritis and in avoiding the occurrence of new renal scars in children younger than 30 months who had VUR.

Pyelonephritis recurred at least once in the first two years of follow-up in 36 per cent (18/50) of children in the prophylaxis group and in 30 per cent (15/50) of children in the control group, the authors report.

During the two years after antibiotic prophylaxis in the intervention group was discontinued, there were only three further cases of pyelonephritis.

The percentage of children with renal scars did not differ between the prophylaxis and control groups during the first two years of follow-up, the investigators found, and there were no patients with new renal damage during the entire follow-up period.

"Our findings do not support the view that VUR predisposes to pyelonephritis and that pyelonephritis can be the cause of progressive damage to renal parenchyma," the authors conclude.

"We are going to follow our cohort to evaluate the possible late complications," Dr. Travan added. "We'll evaluate the approach proposed by the NICE guidelines about a less aggressive diagnostic pattern -- no vesicoureterography if negative ultrasounds executed acutely in a first 'typical' infection."