de Bessa Jose, de Carvalho Mrad Flavia Cristina, Mendes Evilin Feitosa, Bessa Marcia Carvalho, Paschoalin Victor Pereira, Tiraboschi Ricardo Brianezi, Sammour Zein Mohamed, Gomes Cristiano Mendes, Braga Luis H, Bastos Netto José Murillo
Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
Universidade Estadual de Feira de Santana (JdB, EFM, MCB, VPP, RBT), Feira de Santana, Brazil; Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema) (JMBN), Juiz de Fora, Brazil; Universidade Federal de Juiz de Fora (FCdCM, JMBN), Juiz de Fora, Brazil; Universidade de São Paulo, São Paulo, Brazil; Division of Urology, Department of Surgery, McMaster University (LHB), Hamilton, Ontario, Canada.
J Urol. 2015 May;193(5 Suppl):1772-7. doi: 10.1016/j.juro.2014.10.092. Epub 2015 Mar 25.
The followup and treatment of children with vesicoureteral reflux has been debated for many years. Antibiotic prophylaxis has a role for preventing urinary tract infection in these children. Recent studies and guidelines suggested that prophylaxis has little or no role in preventing urinary tract infection in those children, especially those with low grades (I and II) of reflux.
We analyzed all published randomized, controlled trials comparing antibiotic prophylaxis vs no prophylaxis or placebo in children with vesicoureteral reflux. The children were divided into those with nondilated (grades I and II) and dilated (grades III and IV) vesicoureteral reflux. After data were analyzed the RIVUR study was published and, therefore, it was added to the analyzed data.
After analyzing the first published studies we found that antibiotic prophylaxis would be beneficial only in children with high grade vesicoureteral reflux. With the addition of the data in the RIVUR study these results changed. The new pooled data support antibiotic prophylaxis in all children with vesicoureteral reflux.
Vesicoureteral reflux management is still controversial. In contrast to recently published studies and guidelines, this meta-analysis supports antibiotic prophylaxis in all children with vesicoureteral reflux regardless of reflux grade. More studies are needed to support this finding.
小儿膀胱输尿管反流的随访及治疗多年来一直存在争议。抗生素预防在预防这些患儿的尿路感染方面具有一定作用。近期的研究和指南表明，预防措施在预防这些患儿尤其是反流程度较低（I级和II级）的患儿的尿路感染方面作用很小或几乎没有作用。
我们分析了所有已发表的比较抗生素预防与不预防或安慰剂在膀胱输尿管反流患儿中的随机对照试验。将患儿分为膀胱输尿管反流未扩张（I级和II级）和扩张（III级和IV级）两组。在数据分析后，RIVUR研究发表，因此将其纳入分析数据中。
在分析最初发表的研究后，我们发现抗生素预防仅对重度膀胱输尿管反流患儿有益。随着RIVUR研究数据的加入，这些结果发生了变化。新的汇总数据支持对所有膀胱输尿管反流患儿进行抗生素预防。
膀胱输尿管反流的管理仍存在争议。与最近发表的研究和指南不同，这项荟萃分析支持对所有膀胱输尿管反流患儿进行抗生素预防，无论反流程度如何。需要更多研究来支持这一发现。
