Effects of Antibiotic Prophylaxis on Recurrent UTI in Children
Status:
Completed
Trial end date:
2016-03-01
Target enrollment:
Participant gender:
Summary
Approximately, 3% of males and 8% of females will develop a urinary tract infection (UTI)
during childhood, and most of these will be effectively treated by short-term antibiotic
therapy. A subset of these children (20-48%), will develop recurrent UTI (RUTI), which may
have long-term effects in the form of hypertension or renal damage.
In an effort to prevent RUTIs physicians prescribe sulfamethoxazole-trimethoprim (Septra) or
nitrofurantoin as low dose antibiotic prophylaxis. However, recent evidence suggests that
during prophylactic therapy the body is exposed to antibiotic levels capable of increasing
antibiotic resistance and bacterial virulence. This has been shown to be true in the
uropathogens E. coli and Staphylococcus saprophyticus, yet it is not known if Enterococcus
sp. demonstrate similar mechanisms. Additionally, antibiotics have been shown to disrupt the
natural balance of the human microbiome, potentially leading to major long term problems.
As a uropathogen, enterococci consistently rank in the top 3 causes of RUTI, especially in
children under 3 years of age. Additionally, Enterococcus is notorious for developing
antibiotic resistance and studies have shown that children with enterococcal UTIs exhibit a
higher rate of recurrence than those with non-enterococcal UTIs.
The investigators hypothesize the current practice of antibiotic prophylaxis in children with
RUTI is detrimental and can change the bacterial and sensitivity profiles of these patients.