Antimicrobial prophylaxis with VUR

A multicenter randomized trial (the RIVUR trial) in infants and children (no neonates were included) with vesico-ureteric reflux compared the effects of prophylaxis with cotrimoxazole versus placebo on the rate of recurrent urinary tract infection, renal scarring, treatment failure (a composite outcome of recurrences and scarring), and antimicrobial resistance. There were around 300 patients in each arm of the trial. Children receiving cotrimoxazole prophylaxis had a much lower risk (relative risk 0.55) of developing recurrent urinary tract infection, but there was no difference in the rate of renal scarring (around 10%) in each group. Children receiving cotrimoxazole also had a higher risk of carriage of cotrimoxazole-resistant E. Coli in their stool, and of developing recurrent UTI with a resistant pathogen.

Antimicrobial prophylaxis for children with vesicoureteric reflux. RIVUR trial investigators, 2014.

Editorial on the RIVUR trial. Ingelfinger and Stapleton, 2014.