Vezikoüreteral Reflüde Antibiyotik Profilaksisi

Abstract

Vesicoureteral reflux (VUR) which is associated with bladder dysfunction and increased risk of urinary tract infection (UTI), is a common and important urinary system abnormality seen in children. Although VUR spontaneously resolves in most of the cases, it might lead to severe complications including reflux nephropathy, hypertension, UTI and bladder dysfunction. The continuous antibiotic prophylaxis (CAP) in the management of VUR is first choice of therapy. However, controversy exists on CAP in the current studies and some questions have not been properly answered yet. In this paper the recent trends of CAP in VUR is reviewed under current guidelines.

Keywords

• Vesicoureteral Reflux
• Prophylaxis
• Antibiotic

Vezikoüreteral Reflüde Antibiyotik Profilaksisi

Abstract

Primer vezikoüreteral reflü (VUR) mesane disfonksiyonu ve üriner sistem enfeksiyonu riskinde artıșla yakından ilișkili olan çocukluk çağına ait sık ve önemli bir patolojidir. VUR tanısı alan çocukların çoğunda kendiliğinden geçse de, bir kısmında reflü nefropatisi, hipertansiyon, idrar yolu enfeksiyonu ve mesane disfonksiyonu gibi olumsuz sonuçlar doğurabilmektedir. Antibiyotik profilaksisi VUR’lu hastalarda ilk tedavi seçeneği olarak kabul edilirken son çalıșmalara bakıldığında kesin bir görüș birliği olmadığı izlenmektedir. Bu derlemede primer VUR’de antibiyotik profilaksisine güncel yaklașımlar güncel kılavuzlar eșliğinde değerlendirilmiștir.

Keywords

• Vezikour̈ eteral Reflu
• ̈ Pprofilaksi
• Antibiyotik

References

1. 1. Lopez PJ, Celis S, Reed F, et al. Vesicoureterareflux: current management in children. Curr Urol Rep. 2014;15: 447.
2. 2. Hollowell JG, Greenfield SP . Screening siblings for vesicoureteral reflux . J Urol 2002; 168: 2138 – 41.
3. 3. Baquerizo BV, Peters CA. Antibiotic prophylaxis and reflux: critical review and assessment. F1000Prime Rep. 2014; 6: 104.
4. 4. Roussey-Kesler G, Gadjos V, Idres N, et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol. 2008; 179: 674-9.
5. 5. Brandström P, Esbjörner E, Herthelius M, et al. The Swedish reflux trial in children: I. Study design and study population characteristics. J Urol. 2010; 184: 274-9.
6. 6. Craig JC , Simpson JM , Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 2009; 361: 1748 – 59.
7. 7. Montini G, Rigon L , Zucchetta P, et al. Prophylaxis after first febrile urinary tractinfection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics 2008 ; 122 : 1064 – 71.
8. 8. Hoberman A, Greenfield SP, Mattoo TK, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014 19; 370: 2367-76.

9. 9. Tekgül S, Riedmiller H, Hoebeke P, et al. EAU guidelines on vesicoureteral reflux in children. Eur Urol. 2012; 62: 534-42.
10. 10. Peters CA, Skoog SJ , Arant BS Jr, et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children . J Urol 2010; 184: 1134 – 44.
11. 11. Garin EH, Olavarria F, Garcia Nieto V, et al. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006; 117: 626-32.
12. 12. Pennesi M, Travan L, Peratoner L, et al. Is antibiotic prophylaxis in children with reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 2008;121:1489-94.
13. 13. Hari P, Hari S, Sinha A, et al. Antibiotic prophylaxis in the management of vesicoureteric reflux: a randomized doubleblind placebo-controlled trial. Pediatr Nephrol. 2015; 30: 479-86.