Taking off antibiotic prophylaxis in children with vesicoureteral reflux, Is it possible and save?

ABSTRACT

To evaluate the outcome of taking off antibiotics prophylaxis in children with persistent vesicoureteral reflux.48 children with primary vesicoureteral reflux were taken off prophylactic antibiotics in Shebin Al Koom Teaching Hospital Between 1996 and 2007. The criteria for discontinuing antibiotics were children older than 4 years with a normal voiding pattern, no significant hydronephrosis or renal scars and a minimal history of urinary tract infection [UTI]. Exclusion criteria were neurogenic bladder, severe voiding dysfunctions, posterior uretheral valve and ectopic ureter. Routine follow up included duration of on and off antibiotic, grade of reflux at the time of stopping antibiotics, the occurrence of UTI and renal sonography. Sex distribution was 6 boys [12.5%] and 42 girls [87.5%]. The mean patient age when stopping antibiotic was 7.2 years. VUR was bilateral in 22 patients [45.8%], on the right side in 10 patients [20.8%] and on the left side in 16 patients [33.4%]. Reflux was grade I in 8 patients [16.7%], grade II in 36 patients [75%] and grade III in 4 patients [8.3%]. UTIs was found in 6 patients [12.5%] after antibiotic stopping, four of them had cystitis and the other two had febrile UTIs. None of our study developed new renal scars. Taking off antibiotic prophylaxis is possible, safe and acceptable option in a selected patient population with VUR