Creating Waves of Awareness
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 effectiveness of continuous antibiotic prophylaxis for children with vesicoureteral reflux, and randomized, controlled trials are still needed to determine the effectiveness of long-term antibiotics for the prevention of acute pyelonephritis. In this multicenter, open-label,randomized, controlled trial, we tested the effectiveness of antibiotic prophylaxis in preventing recurrence of pyelonephritis and avoiding new scars in a sample of children who were younger than 30 months and vesicoureteral reflux.
METHODS. One hundred patients with vesicoureteral reflux (grade II, III, or IV) diagnosed with cystourethrography after a first episode of acute pyelonephritis were randomly assigned to receiveantibiotic prophylaxis with sulfamethoxazole/trimethoprim or not for 2 years. The main outcome of the study was the recurrence of pyelonephritis during a follow-up period of 4 years. During follow-up, the patients were evaluated through repeated cystourethrographies, renal ultrasounds, and dimercaptosuccinic acid scans.
RESULTS. The baseline characteristics in the 2 study groups were similar. There were no differences in the risk for having at least 1 pyelonephritis episode between the intervention andcontrol groups. At the end of follow-up, the presence of renal scars was the same in children with and without antibiotic prophylaxis.
CONCLUSIONS. Continuous antibiotic prophylaxis was ineffective in reducing the rate of pyelonephritis recurrence and the incidence of renal damage in children who were younger than 30 months and 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
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.
Dear Dr Harold ~ I am reading in wikipedia that Mannose is not well metabolized in humans.
Is this different from the D- Mannose?
As a homeopathy website, we may be interested in learning homeopathic approach to these problems.
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.