Selective Antimicrobial Prophylaxis for Vesicoureteral Reflux

This editorial examines the debate around continuous antibiotic prophylaxis for preventing urinary tract infections (UTIs) in children with vesicoureteral reflux. While some trials have shown significant reductions in UTIs, others report minimal or no benefit, particularly in males or children without prior UTIs. The article discusses recent findings from a multicenter trial involving infants with high-grade reflux and congenital anomalies, which demonstrated reduced first UTI risk but no difference in kidney scarring or renal function. The piece emphasizes limitations in trial design, heterogeneity among studies, and shifting guidelines from professional societies, which now advocate for selective prophylaxis based on individual risk factors like age, sex, reflux grade, and renal anomalies.

This editorial examines the debate around continuous antibiotic prophylaxis for preventing urinary tract infections (UTIs) in children with vesicoureteral reflux. While some trials have shown significant reductions in UTIs, others report minimal or no benefit, particularly in males or children without prior UTIs. The article discusses recent findings from a multicenter trial involving infants with high-grade reflux and congenital anomalies, which demonstrated reduced first UTI risk but no difference in kidney scarring or renal function. The piece emphasizes limitations in trial design, heterogeneity among studies, and shifting guidelines from professional societies, which now advocate for selective prophylaxis based on individual risk factors like age, sex, reflux grade, and renal anomalies.