Update on Continuous Antibiotic Prophylaxis in Pediatric Urology

Teyfon Adam^*
*Correspondence: Teyfon Adam, Department of Pathology, University Mahidol, Bangkok, Thailand, Email:

Introduction

A more specialised and personalised approach to healthcare is now possible because to studies that make it easier to identify kids who would most likely benefit from antibiotic prophylaxis. The advantages and disadvantages of antibiotic prophylaxis are explored in this article in relation to a number of common paediatric urologic disorders, including VUR, prenatally diagnosed HN, and hydroureter. For each disease, patient traits that put the child at an elevated risk of UTI and its aftereffects are listed. We explore the potential long-term negative effects of prophylactic antibiotics on bacterial resistance, the microbiome, and other factors. The article's overview of the developing topic of prophylactic antibiotic alternatives, including prebiotics and probiotics, comes to a close.

Prophylaxis, a Greek term, means "to guard or avoid beforehand." The goal of antibiotic prophylaxis in paediatric urology is to prevent urinary tract infections (UTIs) in children who are at risk, such as those with hydroureteronephrosis and vesicoureteral reflux (VUR). Both benefits and risks of antibiotic prophylaxis for paediatric urologic diseases have been established. Antibiotic prophylaxis is at best unnecessary and at worst hazardous for all children with VUR, as well as those who have all degrees of hydronephrosis (HN) and hydroureteronephrosis. It is unknown whether prophylactic antibiotics will have a positive or negative effect on the body as it ages and develops.

Description

The most heated debate in paediatric urology revolves around the use of CAP in children with VUR. Antibiotics are unquestionably effective at killing bacteria and preventing UTIs. The Randomized Intervention for Vesicoureteral Reflux (RIVUR) and Swedish Reflux trials both found that children who received CAP had fewer UTIs. What is still being debated is the practise of putting every child with VUR on CAP [1-3]. Furthermore, there is still debate about whether children should have a voiding cystourethrogram and be diagnosed with VUR after their first febrile UTI. Over the last two decades, there has been a growing recognition that many children with VUR do not benefit from diagnosis or treatment. Many children's reflux is self-limited and innocuous; however, a subset of children with VUR benefit from both diagnosis and treatment with either CAP or surgical intervention.

Multiple risk factors for recurrent UTI, persistent VUR, pyelonephritis, and renal scars have now been identified, and when considered together, they help to better identify which children will benefit from antibiotic prophylaxis and which will not. The severity or grade of VUR has been used as a primary factor in predicting spontaneous reflux resolution and the risk of pyelonephritis and renal injury. Higher grades of reflux are linked to lower resolution rates and an increased prevalence of renal scars. Furthermore, VUR occurring earlier during bladder filling has been shown to be a risk factor for breakthrough UTIs regardless of grade. Other factors that predict reflux resolution, UTI, and/or the risk of renal injury, in addition to grade and bladder volume at the onset of reflux, include gender, age, race, laterality, bladder pressure at the onset of reflux, the presence of renal scars, the presence of bowel and bladder dysfunction, and a history of recurrent UTIs.

The most significant assessable risk factors for the development of UTI in children are bladder and bowel dysfunction (BBD). Even when they are on CAP, children with VUR and bowel and/or bladder dysfunction are especially predisposed to recurrent pyelonephritis. The cost of recurring UTIs is estimated to be occurring in approximately 45% to 56% of these children, compared to 15% to 25% of children who do not have BBD. Furthermore, children with BBD have a higher incidence of renal scarring, a lower rate of spontaneous resolution, and a higher failure rate after antireflux surgery [4].

The recurrence rate is highest in the first 3 to 6 months after a UTI and the more frequent and recurring a child's UTI, the more likely he or she is to have another UTI [5]. Neither the AAP nor the National Institute of Health and Care Excellence guidelines recommend routinely prescribing prophylactic antibiotics to infants and children following their first UTI. Prior to the RIVUR and Swedish reflux trials, several small randomised trials involving children with low grades of VUR called into question the efficacy of prophylaxis in children with VUR. Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis was compared to placebo in 607 children with grade I-IV VUR following UTI in the RIVUR trial.

In addition to limiting the situations in which CAP is prescribed, ensuring that only children with documented UTIs receive antibiotic treatment will limit antimicrobial use and reduce antibiotic resistance. According to a recent study, nearly one-third of children under the age of two did not have a urinalysis or a urine culture before being treated with antibiotics for suspected UTI symptoms [2]. This is in direct contrast to the most recent AAP guidelines for UTI management, which recommend obtaining a urine specimen for urinalysis and urine culture in a febrile infant with no obvious source of fever. Furthermore, even if only on an ad hoc basis, proper antibiotic treatment could aid in the reduction of antibiotic resistance.

The microbiota is a group of bacteria, archaea, fungi, protozoa, and viruses that live in different parts of the body. There are an enormous number of microbials that colonise the oral and nasal cavities, the skin surface, and the gastrointestinal tracts in humans. In fact, microbial cells outnumber human cells by a factor of ten, and the colon is the most heavily colonised site. Health care providers are finally realising that microbiota play an important role in normal body function and that a healthy microbiome plays an important role in host immunity, metabolism, and resistance to pathogens [1]. Furthermore, changes in the "normal" microbiota may result in disease states. Health-careassociated infections are examples of the consequences of antibiotic-induced changes in the human microbiota. Antimicrobial therapy is most likely the most significant risk factor for the development of Clostridium difficile-associated diarrhoea. 101 C difficile is naturally present in the gastrointestinal microbiota of some healthy Continuous Antibiotic Prophylaxis 7 people.

It's becoming less typical and ubiquitous to use CAP in a generally nonselective manner for kids with VUR, HN, and hydroureteronephrosis. Now that specific risk factors for UTI, renal damage, and its aftereffects can be identified, CAP can be used more wisely and effectively.

Conclusion

Health care practitioners must utilise CAP cautiously due to the potential long-term negative effects of antibiotics. Reduced usage of antibiotics will slow the spread of bacterial resistance in both the individual and the population levels. Limiting antibiotic use will also have a positive impact on a child's microbiota, which is increasingly understood to be crucial to healthy body development and function.

Acknowledgement

Not applicable.

Conflict of Interest

There is no conflict of interest by author.

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