Written by Hannah Harp
Spoon Feed
For prophylaxis of recurrent UTI in children, nitrofurantoin and cranberry products were most associated with reduction in recurrence of UTI. No interventions reduced kidney scarring.
Summary
This systematic review and network meta-analysis investigated prophylactic options for reducing recurrent urinary tract infections (RUTIs) and kidney scarring in children. Analyzing 23 randomized controlled trials (n=3,335), nitrofurantoin and cranberry products significantly reduced RUTI risk compared to control groups, with nitrofurantoin emerging as the most effective (OR 0.21, 95%CI 0.07–0.65). However, no interventions significantly reduced kidney scarring. Limitations included high heterogeneity across studies, inconsistent definitions of RUTI, and risk of bias in several trials. (AI-assisted)
Urine good hands with nitrofurantoin
This meta-analysis builds on 2014’s RIVUR trial, whose results endorsed antibiotic prophylaxis for children with high-grade vesicoureteral reflux (VUR), and the 2023 PRIDICT study which favored antibiotic prophylaxis in kids with high-grade VUR, even if they’ve never had a UTI before. They pooled studies of children with normal urogenital anatomy and those with VUR of any grade, possibly because (lower grade) VUR can resolve with age and is less likely to run into issues with antibiotic resistance than prophylaxis in other congenital anomalies. A subgroup analysis of patients with VUR was too small to yield certain results.
How does this change my practice?
Today I learned that cranberry products for urinary health isn’t just a traditional home remedy. That is something I will be happy to recommend to my kids with recurrent UTIs while we work out their constipation and toileting issues. I will still be leaving antibiotic prophylaxis and VUR care to my urology colleagues.
Sources
Prophylaxis Options in Children With a History of Recurrent Urinary Tract Infections: A Systematic Review. Pediatrics. 2024 Dec 1;154(6):e2024066758. doi: 10.1542/peds.2024-066758. PMID: 39492618
Works Cited
Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014 Jun 19;370(25):2367-76. doi: 10.1056/NEJMoa1401811. Epub 2014 May 4. PMID: 24795142
Antibiotic Prophylaxis in Infants with Grade III, IV, or V Vesicoureteral Reflux. N Engl J Med. 2023 Sep 14;389(11):987-997. doi: 10.1056/NEJMoa2300161. Epub 2023 Sep 12. PMID: 37702442
