Mannose for Children With Vesicoureteral Reflux

Is Antibiotic Prophylaxis in Children With Vesicoureteral Reflux Effective in Preventing Pyelonephritis and Renal Scars? A Randomized, Controlled Trial

Marco Pennesi, MD^a, Laura Travan, MD, PhD^a, Leopoldo Peratoner, MD^b, Andrea Bordugo, MD^b, Adriano Cattaneo, MD^c, Luca Ronfani, MD, PhD^d, Silvia Minisini, MD^a, Alessandro Ventura, MD^a for the North East Italy Prophylaxis in VUR study group

^a Department of Pediatrics, Institute of Child Health IRCCS Burlo Garofolo, Trieste, Italy
^c Unit of Epidemiology and Biostatistics, Institute of Child Health IRCCS Burlo Garofolo, Trieste, Italy
^d Unit for Health Services Research and International Health, Institute of Child Health IRCCS Burlo Garofolo, Trieste, Italy
^b Department of Pediatrics, "S. Maria degli Angeli" Hospital, Pordenone, Italy

OBJECTIVES. There has been intense discussion on the effectivenessof continuous antibiotic prophylaxis for children with vesicoureteralreflux, and randomized, controlled trials are still needed todetermine the effectiveness of long-term antibiotics for theprevention of acute pyelonephritis. In this multicenter, open-label,randomized, controlled trial, we tested the effectiveness ofantibiotic prophylaxis in preventing recurrence of pyelonephritisand avoiding new scars in a sample of children who were youngerthan 30 months and vesicoureteral reflux.

METHODS. One hundred patients with vesicoureteral reflux (gradeII, III, or IV) diagnosed with cystourethrography after a firstepisode of acute pyelonephritis were randomly assigned to receiveantibiotic prophylaxis with sulfamethoxazole/trimethoprim ornot for 2 years. The main outcome of the study was the recurrenceof pyelonephritis during a follow-up period of 4 years. Duringfollow-up, the patients were evaluated through repeated cystourethrographies,renal ultrasounds, and dimercaptosuccinic acid scans.

RESULTS. The baseline characteristics in the 2 study groupswere similar. There were no differences in the risk for havingat least 1 pyelonephritis episode between the intervention andcontrol groups. At the end of follow-up, the presence of renalscars was the same in children with and without antibiotic prophylaxis.

CONCLUSIONS. Continuous antibiotic prophylaxis was ineffectivein reducing the rate of pyelonephritis recurrence and the incidenceof renal damage in children who were younger than 30 monthsand had vesicoureteral reflux grades II through IV.

Key Words: vesicoureteral reflux • antibiotic prophylaxis • pyelonephritis • renal scars

Abbreviations: VUR—vesicoureteral reflux • RCT—randomized, controlled trial • UTI—urinary tract infection • DMSA—dimercaptosuccinic acid • RR—relative risk • CI—confidence interval

Accepted Nov 30, 2007

What is Vesicoureteral Reflux?

Urine normally flows in one direction—down from the kidneys, through tubes called ureters, to the bladder. Vesicoureteral reflux (VUR) is the abnormal flow of urine from the bladder back into the ureters.

VUR is most commonly diagnosed in infancy and childhood after the patient has a urinary tract infection (UTI). About one-third of children with a UTI are found to have VUR. VUR can lead to infection because urine that remains in the child’s urinary tract provides a place for bacteria to grow. But sometimes the infection itself is the cause of VUR.

Tags: infection, mannose, reflux, tract, ureter, urinary

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Permalink Reply by Debby Bruck on May 9, 2011 at 11:33pm

Dear Dr Harold ~ I am reading in wikipedia that Mannose is not well metabolized in humans.

Mannose is not well metabolized in humans.^[1] Therefore, it does not significantly enter the carbohydrate metabolism when taken orally, and although traces of exogeneously introduced mannose have been detected in all body tissues, using radioactive markers, in a well hydrated mammal, although further studies are necessary, 90% of mannose ingested is excreted unconverted into the urine within 30 – 60 minutes, with 99% of the remainder being excreted within the following 8 hours. There is no significant increase in blood-glucose levels during this time.

Is this different from the D- Mannose?

D-mannose is sold as a naturopathic remedy for urinary tract infections, and it is claimed to work through the disruption of adherence of bacteria in the urinary tract. Wikipedia
Visiting Dr Jonathan Wright's page explains in simple terms how the D-Mannose works to prevent the E-coli from sticking in the bladder and helping with kidney infections.

As a homeopathy website, we may be interested in learning homeopathic approach to these problems.

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Permalink Reply by haroldjitschak bueno de mesquita on May 10, 2011 at 3:34am

I posted the article about mannose because I mentioned it in the asa foetida posting.

As children may be loaded with antibiotics for a year or longer if suffering from reflux, I thought it might be useful to bring this knowledge to the forum as well.

Regarding your question: I don't know anything about homeopathic prevention of urinary tract infections but again it is remarkable that Grandgeorge writes under sepia :

" a great sensitivity to E.coli bacteria"

Your remark may remind me to try this out as well in the future [but to keep mannose at hand as well because a pyelonephritis[inflammation of the upper urinary tract is a dangerous condition!]

I have seen mannose been working far better than cranberry and not alone against coli.