Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair M D, Raymond F, Grellier A, Hazart I, de Parscau L, Salomon R, Champion G, Leroy V, Guigonis V, Siret D, Palcoux J B, Taque S, Lemoigne A, Nguyen J M, Guyot C
Medical Pediatric Clinic, Hospital Center and University of Nantes, Nantes, France.
J Urol. 2008 Feb;179(2):674-9; discussion 679. doi: 10.1016/j.juro.2007.09.090. Epub 2007 Dec 20.
Antibiotic prophylaxis is given to children at risk for urinary tract infection. However, evidence concerning its effectiveness in grade I to III vesicoureteral reflux is lacking. The objective of this study was to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infection in young children with low grade vesicoureteral reflux.
Children 1 month to 3 years old with grade I to III vesicoureteral reflux were assigned randomly to receive daily cotrimoxazole or no treatment, and followed for 18 months. A urinary tract infection constituted an exit criterion. Infection-free survival rates were calculated using the Kaplan-Meier method and compared using the log rank test.
A total of 225 children were enrolled in the study. Distribution of gender, age at inclusion and reflux grade were similar between the 2 groups. There was no significant difference in the occurrence of urinary tract infection between the 2 groups (17% vs 26%, p = 0.2). However, a significant association was found between treatment and patient gender (p = 0.017). Prophylaxis significantly reduced urinary tract infection in boys (p = 0.013), most notably in boys with grade III vesicoureteral reflux (p = 0.042).
These data suggest that antibiotic prophylaxis does not reduce the overall incidence of urinary tract infection in children with low grade vesicoureteral reflux. However, such a strategy may prevent further urinary tract infection in boys with grade III reflux.
对有尿路感染风险的儿童给予抗生素预防治疗。然而，关于其在I至III级膀胱输尿管反流中有效性的证据尚缺。本研究的目的是确定抗生素预防治疗是否能降低轻度膀胱输尿管反流幼儿的尿路感染发生率。
将1个月至3岁患有I至III级膀胱输尿管反流的儿童随机分配，分别接受每日复方新诺明治疗或不治疗，并随访18个月。尿路感染构成退出标准。采用Kaplan-Meier法计算无感染生存率，并使用对数秩检验进行比较。
共有225名儿童纳入本研究。两组间性别、纳入时年龄及反流分级分布相似。两组间尿路感染发生率无显著差异（17%对26%，p = 0.2）。然而，发现治疗与患者性别之间存在显著关联（p = 0.017）。预防治疗显著降低了男孩的尿路感染发生率（p = 0.013），在III级膀胱输尿管反流男孩中最为明显（p = 0.042）。
这些数据表明，抗生素预防治疗并不能降低轻度膀胱输尿管反流儿童的总体尿路感染发生率。然而，这种策略可能预防III级反流男孩发生进一步的尿路感染。
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