Primer Vezikoüreteral Reflü Profilaksisinde Amoksisilinin Uzun Dönem Etkinliğinin Değerlendirilmesi

Abstract

Amaç: Vezikoüreteral reflü (VUR)’un konservatif tedavisinde antibiyotik profilaksisi uzun zamandan beri kullanılmaktadır. Bu çalışmada antibiyotik profilaksis olarak amoksisilinin uzun dönem etkinliği araştırıldı. Gereç ve Yöntem: VUR tanısı ile takip edilen ve en az 6 ay ve daha uzun süre amoksisilin profilaksisi alan hastaların klinik özellikleri ve izlem sonuçları retrospektif olarak araştırıldı. Bulgular: Çalışmaya 13’ü kız (%29.5), 31’i erkek (%70.5) olmak üzere 44 hasta alındı ve yaş ortalaması 2.9±1.3 aydı. Ortalama 27.4±19.4 ay takipte 9 hastada (%20.5) bir kez idrar yolu enfeksiyonu (İYE) ve 2 hastada (%4.5) ateşli İYE tespit edildi. İki hasta ateşli İYE, 2 hastada ise gastrointestinal yan etkiler olmak üzere toplam 4 hastada (%9) antibiyotik revizyonu yapıldı. Sonuç: VUR’lu hastaların amoksisilin profilaksisi ile uzun dönem takibi etkili ve güvenilir bir tedavi seçeneğidir.

Keywords

• vezikoüreteral reflü
• idrar yolu enfeksiyonu
• amoksisilin

Long-term Effectiveness of Amoxicillin Prophylaxis for Children with Primary Vesicoureteral Reflux

Abstract

Aim: The use of antibiotic prophylaxis in the conservative treatment of vesicoureteral reflux (VUR) has a long historical precedent. In this study, we investigated the long-term efficacy of amoxicillin as antibiotic prophylaxis. Materials and Methods: A retrospective investigation was conducted to examine the clinical characteristics and follow-up results of patients with VUR who received amoxicillin prophylaxis for at least of six months. Results: A total of 44 patients were included in the study, comprising 13 girls (29.5%) and 31 boys (70.5%), with a mean age of 2.9±1.3 months. During a mean follow-up period of 27.4±19.4 months, nine patients (20.5%) experienced one urinary tract infection (UTI), while two patients (4.5%) had a febrile UTI. Antibiotic revision was performed in a total of four patients (9%), including two patients with a febrile UTI and two patients with gastrointestinal side effects. Conclusion: The long-term follow-up of patients with VUR who have been treated with amoxicillin prophylaxis has demonstrated that this is an effective and safe treatment option.

Keywords

• vesicoureteral reflux
• urinary tract infection
• amoxicillin

References

1. 1. Mattoo TK. Vesicoureteral reflux and reflux nephropathy. Adv Chronic Kidney Dis. 2011;18(5):348-54.
2. 2. Johnston DL, Qureshi AH, Irvine RW, Giel DW, Hains DS. Contemporary Management of Vesicoureteral Reflux. Curr Treat Options Pediatr. 2016;2(2):82-93.
3. 3. Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, Pohl HG, Kropp BP, Skoog SJ, Nelson CP, Moxey-Mims M, Chesney RW, Carpenter MA. Antimicrobial prophylaxis for children with vesicoureteral reflux N Engl J Med. 2014;370(25):2367-76.
4. 4. Min Xie, Xiaogai Xu, Zhenjie Cao, Huijie Xiao. Do Various Treatment Modalities of Vesicoureteral Reflux Have Any Adverse Effects in Pediatric Patients? A Meta-Analysis. Urol Int. 2021;105(11-12):1002-1010.
5. 5. Läckgren G, Cooper CS, Neveus T, Kirsch AJ. Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years? Front Pediatr. 2021;9:650326.
6. 6. Johnston DL, Qureshi AH, Irvine RW, Giel DW, Hains DS. Contemporary Management of Vesicoureteral Reflux. Curr Treat Options Pediatr. 2016;2(2):82-93.
7. 7. Shaikh N, Lee S, Krumbeck JA, Kurs-Lasky M. Support for the use of a new cutoff to define a positive urine culture in young children. Pediatrics. 2023;152(4):e2023061931.
8. 8. Urine collection methods and dipstick testing in non-toilet-trained children. Diviney J, Jaswon MS. Pediatr Nephrol. 2021;36(7):1697-1708.

9. 9. Miyakita H, Hayashi Y, Mitsui T, Okawada M, Kinoshita Y, Kimata T et al. Guidelines for the medical management of pediatric vesicoureteral reflux. Int J Urol. 2020;27(6):480-490.
10. 10. Rivur Trial Investigators. Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014; 370:2367–76.
11. 11. Brandström P, Esbjörner E, Herthelius M, Swerkersson S, Jodal U, Hansson S. The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol. 2010;184:286–91.
12. 12. Cendron M. Antibiotic prophylaxis in the management of vesicoureteral reflux. Adv Urol. 2008;2008:825475.