Pennesi Marco, Travan Laura, Peratoner Leopoldo, Bordugo Andrea, Cattaneo Adriano, Ronfani Luca, Minisini Silvia, Ventura Alessandro
Clinica Pediatrica, Istituto per l'Infanzia IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34100 Trieste, Italy.
Pediatrics. 2008 Jun;121(6):e1489-94. doi: 10.1542/peds.2007-2652. Epub 2008 May 19.
There has been intense discussion on the effectiveness of continuous antibiotic prophylaxis for children with vesicoureteral reflux, and randomized, controlled trials are still needed to determine the effectiveness of long-term antibiotics for the prevention of acute pyelonephritis. In this multicenter, open-label, randomized, controlled trial, we tested the effectiveness of antibiotic prophylaxis in preventing recurrence of pyelonephritis and avoiding new scars in a sample of children who were younger than 30 months and vesicoureteral reflux.
One hundred patients with vesicoureteral reflux (grade II, III, or IV) diagnosed with cystourethrography after a first episode of acute pyelonephritis were randomly assigned to receive antibiotic prophylaxis with sulfamethoxazole/trimethoprim or not for 2 years. The main outcome of the study was the recurrence of pyelonephritis during a follow-up period of 4 years. During follow-up, the patients were evaluated through repeated cystourethrographies, renal ultrasounds, and dimercaptosuccinic acid scans.
The baseline characteristics in the 2 study groups were similar. There were no differences in the risk for having at least 1 pyelonephritis episode between the intervention and control groups. At the end of follow-up, the presence of renal scars was the same in children with and without antibiotic prophylaxis.
Continuous antibiotic prophylaxis was ineffective in reducing the rate of pyelonephritis recurrence and the incidence of renal damage in children who were younger than 30 months and had vesicoureteral reflux grades II through IV.
关于持续抗生素预防对膀胱输尿管反流患儿的有效性一直存在激烈讨论，仍需要随机对照试验来确定长期使用抗生素预防急性肾盂肾炎的有效性。在这项多中心、开放标签、随机对照试验中，我们测试了抗生素预防在预防肾盂肾炎复发和避免新瘢痕形成方面的有效性，研究对象为30个月以下且患有膀胱输尿管反流的儿童样本。
100例在首次急性肾盂肾炎发作后经膀胱尿道造影诊断为膀胱输尿管反流（II级、III级或IV级）的患者被随机分配接受或不接受磺胺甲恶唑/甲氧苄啶抗生素预防治疗2年。该研究的主要结局是4年随访期内肾盂肾炎的复发情况。在随访期间，通过重复膀胱尿道造影、肾脏超声和二巯基丁二酸扫描对患者进行评估。
2个研究组的基线特征相似。干预组和对照组在至少发生1次肾盂肾炎发作的风险方面没有差异。随访结束时，接受和未接受抗生素预防的儿童肾脏瘢痕的存在情况相同。
对于30个月以下且患有II至IV级膀胱输尿管反流的儿童，持续抗生素预防在降低肾盂肾炎复发率和肾脏损害发生率方面无效。
