Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta-analysis

Objective To evaluate the effectiveness and safety of long-term prophylactic antibiotics for recurrent urinary tract infection (UTI) in children through meta-analysis of randomised controlled trials. Methods Electronic databases and reference lists of review articles were searched for relevant trials. Outcome measures were recurrence of symptomatic UTI, repeat positive urine culture, new or deteriorated renal scarring and adverse events during and after treatment. Results Eleven trials with 2046 patients were identified. Analysis suggested rates of recurrent symptomatic UTI were not significantly different between antibiotic (12.4%) and control groups (15.5%) (RR 0.83, 95% CI 0.66 to 1.05). Subsequent sensitivity and subgroup analyses according to patient vesicoureteric reflux (VUR) status, patient characteristics, history of UTI, site of UTI and duration of treatment also produced no significant effect. However, when trials were divided by study quality, only in trials with adequate allocation concealment was recurrent symptomatic UTI reduced by antibiotic prophylaxis. Prophylactic antibiotics reduced the risk of repeat positive urine culture (RR 0.50, 95% CI 0.34 to 0.74). A subgroup analysis limited to patients without VUR showed similar results (0.52, 0.33 to 0.83), whereas patients with VUR showed a non-significant decrease (0.82, 0.61 to 1.09) in risk of repeat positive urine culture. Seven studies reported the rate of new or deteriorated renal scars and showed no significant difference (0.95, 0.51 to 1.78). Conclusions Evidence is lacking that prophylactic antibiotics reduce the incidence of recurrent childhood UTI. Since the reviewed studies had limitations in methodological design, large scale, high quality, placebo-controlled, double-blind trials are required.