What are the AAP guidelines on the use of antibacterial prophylaxis in pediatric urinary tract infection (UTI)?

Updated: Mar 19, 2019
  • Author: Donna J Fisher, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

In theory, VCUG results could guide the use of antibacterial prophylaxis. However, data do not support the use of prophylaxis to prevent recurrent febrile UTI in infants with no VUR or with grade 1-4 VUR. [38] Consequently, the AAP no longer recommends the routine use of VCUG after the first UTI. [3]

This topic remains controversial. More definitive evidence on the benefit of antibiotic prophylaxis in children with VUR—and thus on the indications for VCUG in pediatric patients with UTI—is anticipated from the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) study, which is ongoing. [39]

Some clinicians recommend waiting 4-6 weeks after febrile UTI is treated to perform VCUG. If the child is given suppressive antibacterial treatment during this period, this recommendation is acceptable. However, studies have shown that the VCUG may be obtained within the first few days of treating febrile UTI if the voiding pattern has returned to its pre-UTI state. [40, 41, 42]


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