Al-Sayyad Ahmed J, Pike John G, Leonard Michael P
Division of Pediatric Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
J Urol. 2005 Oct;174(4 Pt 2):1587-9; discussion 1589. doi: 10.1097/01.ju.0000176336.67905.c7.
We review the outcome of stopping prophylactic antibiotics in children with persistent vesicoureteral reflux (VUR).
We performed a retrospective chart review of patients with VUR followed off antibiotics during the last 12 years. Selection criteria included children 4 years old or older who were toilet trained, could verbalize and had a normal voiding pattern. Exclusion criteria were posterior urethral valves, ectopic ureter, neurogenic bladder and severe voiding dysfunction. Outcome measures were age at stopping antibiotics, duration on and off antibiotics, grade of reflux at the time of stopping antibiotics, the occurrence of urinary tract infections (UTI) and new renal scarring on followup. All patients had upper tract assessment performed with renal ultrasound.
A total of 67 girls (85.9%) and 11 boys (14.1%) were included in the analysis. VUR was bilateral in 36 patients (46.2%), on the left side in 29 (37.2%) and on the right side in 13 (16.7%). Reflux was grade I in 16.7% of the cases, II in 75.6% and III in 7.7%. Mean patient age when taken off antibiotics was 5.74 years. The period on prophylactic antibiotics ranged from 0 to 84 months (mean 26.2) and the period off antibiotics ranged from 5 to 138 months (37.7). UTI developed in 9 girls (11.5%), of whom 8 had cystitis (10.2%) and 1 had clinically presumptive pyelonephritis (1.3%). These 9 girls were off antibiotics 5 to 60 months (mean 21.1). None of our patients, including those with UTI, had new renal scarring on followup renal ultrasound.
Discontinuing prophylactic antibiotics in selected school age children is safe practice. The risk of significant upper tract infection is low and the development of new renal scars unlikely. However, we fully acknowledge that renal ultrasound is not the most accurate investigation for detection of renal scars. Therefore, continuing medical surveillance of these children is important.
我们回顾了停止对患有持续性膀胱输尿管反流（VUR）的儿童使用预防性抗生素的结果。
我们对过去12年中停用抗生素后接受随访的VUR患者进行了回顾性病历审查。选择标准包括4岁及以上已接受如厕训练、能够表达且排尿模式正常的儿童。排除标准为后尿道瓣膜、异位输尿管、神经源性膀胱和严重排尿功能障碍。观察指标为停用抗生素时的年龄、使用和停用抗生素的持续时间、停用抗生素时的反流分级、尿路感染（UTI）的发生情况以及随访时新出现的肾瘢痕。所有患者均接受了肾脏超声对上尿路的评估。
共有67名女孩（85.9%）和11名男孩（14.1%）纳入分析。VUR为双侧的有36例（46.2%），左侧29例（37.2%），右侧13例（16.7%）。反流I级的病例占16.7%，II级占75.6%，III级占7.7%。停用抗生素时患者的平均年龄为5.74岁。预防性抗生素使用时间为0至84个月（平均26.2个月），停用抗生素时间为5至138个月（平均37.7个月）。9名女孩（11.5%）发生了UTI，其中8例为膀胱炎（10.2%），1例为临床疑似肾盂肾炎（1.3%）。这9名女孩停用抗生素5至60个月（平均21.1个月）。在随访肾脏超声检查中，包括那些发生UTI的患者在内，我们的患者均未出现新的肾瘢痕。
在选定的学龄儿童中停用预防性抗生素是安全的做法。严重上尿路感染的风险较低，新肾瘢痕形成的可能性不大。然而，我们完全认识到肾脏超声并非检测肾瘢痕最准确的检查方法。因此，对这些儿童继续进行医学监测很重要。
