Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Expert Rev Anti Infect Ther. 2010 Jan;8(1):51-8. doi: 10.1586/eri.09.111.
The main concern in the management of children with vesicoureteral reflux (VUR) is the prevention of urinary tract infections and avoidance of renal damage. Medical management has been recommended or preferentially suggested over surgery in all but a few select clinical situations. Prophylactic antibiotics are prescribed routinely in the management of young children with radiological evidence of VUR following an episode of acute pyelonephritis. Prophylaxis is generally maintained until the VUR resolves spontaneously or is corrected surgically. Although the administration of prophylactic antibiotics has been universal in children with VUR, some authors have reported that long-term antibiotic prophylaxis does not fully prevent urinary tract infections or scarring, that antibiotic-related adverse events are known to occur, and that the incidence of pyelonephritis does not increase in spite of prophylactic antibiotic cessation. Recently, four prospective, randomized, controlled trials of antibiotic prophylaxis for preventing pyelonephritis and renal scarring were reported and some placebo-controlled, double-blind prospective studies are ongoing. The goal of this review is to evaluate the treatment of VUR using antibiotic prophylaxis, and its advantages and disadvantages based on appropriate descriptions and studies in the literature.
管理儿童膀胱输尿管反流（VUR）的主要关注点是预防尿路感染和避免肾脏损伤。除了少数特定临床情况外，医学管理一直被推荐或优先建议用于手术治疗。对于有放射学证据的 VUR 且曾发生过急性肾盂肾炎的幼儿，常规预防性使用抗生素进行管理。通常在 VUR 自发消退或手术矫正之前，维持预防治疗。尽管预防性使用抗生素在 VUR 患儿中普遍存在，但一些作者报告称，长期抗生素预防并不能完全预防尿路感染或瘢痕形成，已知会发生与抗生素相关的不良事件，并且尽管停止预防性抗生素治疗，肾盂肾炎的发生率并未增加。最近，四项预防肾盂肾炎和肾脏瘢痕形成的抗生素预防前瞻性随机对照试验和一些安慰剂对照、双盲前瞻性研究正在进行中。本综述的目的是评估使用抗生素预防治疗 VUR 的效果，并根据文献中的适当描述和研究，评估其优缺点。
