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Pediatric vesicoureteral reflux: treatment patterns and outcomes

Nature Clinical Practice Urology volume 4, pages 462–463 (2007)Cite this article

Clinical practice guidelines suggest that patients diagnosed with vesicoureteral reflux (VUR) should be started on prophylactic antibiotic therapy to prevent urinary tract infection (UTI) and potential renal scarring. The results of our study, in which we reviewed the medical and pharmacy claim data of 11,000 children under the age of 11 years with a diagnosis of VUR, reflect these guidelines, with 76% of VUR patients initiated on antibiotic therapy.1 Compliance with antibiotic therapy, however, was very poor. The overall rate of compliance was 41.4%, with only 17% of patients having antibiotic coverage over at least 80% of the year following diagnosis of VUR, and less than 10% having antibiotic coverage throughout the entire year. These findings reflect a pattern of poor antibiotic compliance in children with VUR, supporting previous work from Panaretto et al.2 who found only 17% of these patients actually had a urine sample positive for antibiotics, even though 57% of parents reported that their child was using antibiotics prophylactically during the 12-month period. The low rates of antibiotic compliance found in our study might place patients at an increased risk of developing renal damage or recurrent UTIs.

Also in our study, almost 60% of patients receiving antibiotics still had an infection within 1 year of being diagnosed with VUR. Of patients deemed to be 100% compliant with antibiotic therapy, 64% had at least one UTI diagnosis.1 These rates are strikingly high considering that prevention of UTIs and subsequent renal scarring is the primary objective when caring for patients with VUR. The results of this study, while not designed to test the efficacy of antibiotic prophylaxis, do add to the literature that questions the effectiveness of the antibiotic prophylaxis treatment strategy for VUR patients.3,4

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References

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Authors and Affiliations

  1. TW Hensle is the Given Professor of Urology and Vice Chairman of the Department of Urology, Columbia University College of Physicians and Surgeons, Children's Hospital of New York, New York, NY, USA.,

    Terry W Hensle

  2. AL Grogg is Associate Director and M Eaddy is Senior Consultant, Applied Health Outcomes, Palm Harbor, FL, USA.,

    Amy L Grogg & Michael Eaddy

Authors
  1. Terry W Hensle
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  2. Amy L Grogg
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  3. Michael Eaddy
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Correspondence to Michael Eaddy.

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Hensle, T., Grogg, A. & Eaddy, M. Pediatric vesicoureteral reflux: treatment patterns and outcomes. Nat Rev Urol 4, 462–463 (2007). https://doi.org/10.1038/ncpuro0884

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