Treating VUR with Prophylactic Antibiotics

The American Urology Association guidelines (1997) recommend that children with Vesicoureteral Reflux grades I-IV should be treated with daily antibiotic therapy (also known as prophylactic antibiotics). Prophylactic antibiotics have been used as a first step in treating Vesicoureteral Reflux since the 1960s. The idea is based on the premise that a small daily dose of antibiotics will kill any bacteria in the urine which will keep the bladder sterile, and would therefore be beneficial in preventing UTI and renal scarring. If UTI can be prevented, the kidneys will be protected, and the child can have time for the reflux to resolve without further treatment (most common in the lower grades of reflux).

There are only a few types of antibiotics that can be used for prophylaxis in children with VUR. The most common types used are trimethoprim sulfamethoxazole (Bactrim), nitrofurantoin (Furadantin) and penicillin derivatives of amoxicillin. These antibiotics are used because their active form is excreted in urine which in theory should keep the urine sterile. Trimethoprim sulfamethoxazole (Bactrim) is the most commonly used prophylaxis for the treatment of VUR. The only antibiotic safe for use in children 3 months or younger is the penicillin derivatives of amoxicillin.

There are risks and problems associated with prolonged daily use of antibiotics in treating VUR. These include compliance, side effects, resistant bacteria and effectiveness of the antibiotic. It is generally accepted that children with lower grades of reflux and no other complications (such as hydronephrosis, significant renal scarring, etc) can safely be taken off of antibiotics at the age of 5. Studies have shown that by the age of 5, the chances of renal scarring are significantly reduced.

There has been a lot of debate about the safety and ineffectiveness of antibiotics in recent years. For the purpose of this article, we have given information solely based on the AUA recommendations that antibiotics should be given. For more information on antibiotics and why some believe they are ineffective, please read the article “The Argument Against Prophylactic Antibiotics”.

The information on this web site should not be taken as medical advice, and you should contact your health care provider with any questions regarding your child's condition/health. The information on this site comes from the personal experience and opinions of parents, and does not come from doctors or medical experts, and should be taken as such.