The Debate About Prophylactic Antibiotics

There is a huge debate going on about the use of prophylactic antibiotics for the treatment of VUR. Is it effective? Is it safe? What are there side effects? Are the dangers worth the risk? My first recommendation as always is to do your research, so that you can make an informed decision. Know which antibiotic will be given, the dosage and the side effects. Some kids do great with antibiotics, and experience very few side effects. Other children don't do well at all. As a parent, our job is to make the best decision for our children, and that decision will be different for everyone.

I want to start this article by saying that I am (personally) not a fan of daily antibiotic therapy. Based on my experience and research, I feel like antibiotics are ineffective in preventing recurrent infections , and are accompanied by difficult side effects and potential dangers. That being said, my daughter still takes them every night due to her recurrent VUR and complications. I only add this information because I realize that at first glance this article may seem to be very anti-antibiotics. While I think antibiotics can be dangerous and are not always needed, I also realize that they are still the best option for many children. No one should ever discontinue antibiotics without first discussing it with their doctor.

So what is the big debate?

The current debate is whether or not daily antibiotics are effective in preventing urinary tract infection and renal scarring. Unfortunately there is still no clear cut answer. There have not been enough long term comprehensive studies to provide definitive answers to this question, but many new studies are showing a shift in what scientists believe to be true. For years doctors have been prescribing low dose antibiotics to children with VUR with the belief that antibiotics help in the prevention of UTI. The idea is that the antibiotics will keep the urine sterile which will prevent/reduce the number of breakthrough UTI's.

Many recent studies are beginning to show that antibiotics are not effective in preventing UTI or renal scarring. For example, this study http://pediatrics.aappublications.org/cgi/content/full/117/3/919 concludes that "Furthermore, their data do not support a role for antibiotic prophylaxis to prevent recurrence of infection or the development of renal scars (in fact, in this study, prophylaxis increased the chance of developing APN!)." The most interesting part of the study is that in the 8 patients with VUR that had recurrent kidney infections (APN), 7 of them were on prophylactic antibiotics. Only one child from the group not being treated had recurrent kidney infection. Even more interesting to me, is that all 7 of the children on antibiotics developed bacteria that was resistant to the antibiotic that they were given as a prophylactic. This was a small study in which only 236 patients were enrolled, and larger studies with more specific guidelines are needed, but the conclusions can't be ignored.

Another recent study http://www.springerlink.com/content/1741p5k22284x265/ shows that the use of probiotics may be just as effective as using prophylactic antibiotics. Many have also suggested that early intervention with Deflux injection may be more effective and safer than long term antibiotics. There are more comprehensive studies being conducted currently to verify the findings of this research.

Another question that surfaces when talking about antibiotics is whether or not antibiotics are safe for long term use. There are risks associated with the prolonged use of antibiotics. One of the biggest concerns of long term use is the risk of resistant bacteria. Bacteria can become resistant to antibiotics, causing infections that are harder to kill off, and harder to treat. Many times these bacterial infections will require stronger IV antibiotics, and can lead to more dangerous infections that have fewer treatment options. There is also the fear of a superbug that may have very limited treatment options. Other problems include an increase in problems later in life such as allergies and asthma.

You should also be aware of the drugs side effects. The side effects of different antibiotics will vary in different children. Some of the more general side effects may include, gut issues such as diarrhea or nausea and chronic yeast infection. The problem with antibiotics is that they not only kill the harmful bacteria in the body, but also kill the beneficial bacteria found in the gut. This imbalance can cause uncomfortable gut issues, as well as yeast overgrowth.

So, are the benefits of antibiotics worth the risks? This is such a personal decision, and is a hard question to answer. I know some parents who think that antibiotics are wonderful and feel that they have really helped their children remain healthy. Many kids have no adverse side effects, and no recurrent infections while on antibiotics. Unfortunately, that is not always the case and for some children antibiotics may not be a good solution.

For more information on prophylactic antibiotics and VUR, please check out our links page under 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.