Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: Systematic review and meta-analysis of randomized clinical trials.

BACKGROUND

Controversy persists regarding continuous antibiotic prophylaxis (CAP) for vesicoureteral reflux (VUR) management. We sought to determine whether recent updates to the published literature continue to support the use of CAP in children with VUR.

METHODS

We searched MEDLINE, EMBASE, Google Scholar, and Web of Science Core Collection electronic databases for all trials published of this topic. The study protocol was prospectively registered at PROSPERO (No. CRD42024587765). We included randomized controlled trials (RCTs) with patients 18 years or younger with VUR. Exclusion criteria included studies without reported number of patients treated or number who successfully completed treatment, conference abstracts, and non-English papers. Reports were assessed and data abstracted by two independent reviewers, with differences resolved by consensus. Risk of bias was assessed using standardized instruments.

RESULTS

We identified 2603 studies, of which 13 were included in the meta-analysis with 2577 patients total. Pooled results demonstrated that CAP did significantly reduce the risk of UTI (pooled OR 0.79, 95 % CI 0.65-0.94, p = 0.01). In cases of UTI, there was an increased risk of antibiotic resistance in the CAP group (pooled OR 6.96, 95 % CI 4.35-11.02). There was no difference in the rates of new renal scarring between groups (pooled OR 1.06, 95 % CI 0.78-1.45). Substantial heterogeneity existed between studies with I2 58.12 %. A subgroup analysis, stratified by each study's susceptibility to bias, demonstrated that studies at lower risk of bias had a stronger protective effect from CAP (pooled OR: 0.54, 95 % CI 0.41-0.71).

DISCUSSION: Compared to placebo, observation, or probiotics, CAP significantly reduced the risk of recurrent UTIs; increased the risk of antibiotic resistance; but did not affect rates of new renal scarring. Limitations include risk of bias identified in many studies per Cochrane review and heterogeneity of methods across papers.