Fisch Naama, Ashkenazi Shai, Davidovits Miriam
Department of Pediatrics A, Schneider Children's Medical Center, Petah Tikva, Israel.
Isr Med Assoc J. 2009 Nov;11(11):677-82.
Although febrile urinary tract infections are very common in young children, the need for antimicrobial prophylaxis and evaluation following a first event is controversial.
To assess the approach of leading pediatric specialists throughout israel to antimicrobial prophylaxis.
A questionnaire regarding the approach to antibiotic prophylaxis and diagnostic evaluation following a first event of febrile UTI, according to age and underlying renal abnormality, was sent to all 58 directors of departments of pediatrics, units of pediatric infectious diseases and pediatric nephrology in Israel.
Fifty-six directors (96%) responded. Most prescribed prophylactic antibiotics after UTI. Heads of infectious disease departments prescribed less prophylaxis following UTI at the age of 18 months than heads of pediatrics or heads of pediatric nephrology units (34% vs. 72-75%, P = 0.018), but more often in cases of severe vesico-ureteral reflux without UTI. Cephalosporins were used prophylactically more often by directors of pediatrics compared to heads of pediatric nephrology units (71% vs. 38%, P = 0.048); the latter used non-beta-lactam prophylaxis (61% vs. 23%, P = 0.013) more often. Most pediatricians used renal sonography for evaluation; renal scan was used more commonly by pediatric nephrologists.
The administration of prophylactic antibiotics after UTI is still common practice among pediatric opinion leaders, although the specific approach differs by subspecialty. According to the latest evidence-based data, educational efforts are needed to formulate and implement judicious guidelines.
尽管发热性尿路感染在幼儿中非常常见，但首次发病后是否需要进行抗菌药物预防和评估仍存在争议。
评估以色列各地主要儿科专家对抗菌药物预防的方法。
根据年龄和潜在的肾脏异常情况，向以色列所有58名儿科、儿科传染病和儿科肾脏病科主任发送了一份关于首次发热性尿路感染事件后抗生素预防和诊断评估方法的问卷。
56名主任（96%）回复。大多数人在尿路感染后开具预防性抗生素。传染病科主任在18个月大时尿路感染后开具的预防药物比儿科主任或儿科肾脏病科主任少（34%对72%-75%，P = 0.018），但在无尿路感染的严重膀胱输尿管反流病例中更常开具。与儿科肾脏病科主任相比，儿科主任更常预防性使用头孢菌素（71%对38%，P = 0.048）；后者更常使用非β-内酰胺类预防药物（61%对23%，P = 0.013）。大多数儿科医生使用肾脏超声进行评估；儿科肾脏病医生更常使用肾脏扫描。
尽管具体方法因亚专业而异，但在首次尿路感染后使用预防性抗生素在儿科意见领袖中仍然是常见的做法。根据最新的循证数据，需要开展教育工作以制定和实施明智的指南。
