BACKGROUND: Generally prophylactic antibiotics are given in vesicoureteral reflux (VUR) until there is spontaneous resolution or corrective surgery. Children with dysfunctional elimination syndrome (DES) and VUR have higher rates of breakthrough UTI. We investigated the safety of prophylacitc antibiotic cessation in children with VUR by comparing the rate of recurrent UTI in toilet trained (TT) children with and without VUR after 12 months of antibiotic cessation and treatment of DES.
METHODS: 82 TT children entered into a prospective series after a first febrile UTI. Children with history of UTI, antenatal hydronephrosis, neurogenic bladder, or genitourinary anomaly were excluded. The initial 6 months involved prophylactic antibiotics and aggressive treatment of DES. VUR was diagnosed by VCUG. DES was diagnosed by history and urologic diary. Baseline dysfunctional voiding symptom score (DVSS) was recorded based on symptoms prior to UTI. DVSS was then recorded at the end of the 6 month treatment and 12 month observation periods. Recurrent UTI was compared according to VUR and DES treatment results. Adequate treatment of DES was defined as DVSS<9.
RESULTS: 48 (59%) were VUR+ and 34 (41%) were VUR-. 29 VUR+ children were DES+ and 19 were DES-. 23 VUR- children were DES+ and 11 were DES-. During 6 months of DES treatment there were 2 recurrent UTIs, both DES+. 73 chidlren entered the observation period and were divided into 4 groups. Group 1 (n=15): VUR+/DES-; Group 2 (n=24): VUR+/DES+; Group 3 (n=23): VUR-/DES+; Group 4 (n=11): VUR-/DES-. Recurrent UTI occurred in 2 (13.3%) in Group1, 6 (20.7%) in Group 2, 5 (21.8%) in Group 3, and 0 in Group 4. 13 children had recurrent UTI, 11 (84.6%) were DES+ and 9 (81.8%) had DVSS>9.
CONCLUSIONS: Recurrent UTI after antibiotic cessation was independent of VUR. After treatment of DES, reccurent UTI rate approached that of DES- children. Antibiotic cessation is safe in TT children with VUR if DES is adequately treated.