Q: What are your thoughts on long-term prophylactic antibiotic use to prevent urinary tract infections (UTIs) and kidney scarring in children diagnosed (by VCUG—voiding cysto-urethrogram, a test to determine vesiculouretal reflex VUR) with grade II vesiculouretal reflux (a condition that causes urine to move backwards from the bladder up to the kidneys)? Is it effective in your experience? What concerns should a parent have about long-term antibiotic use and what additional supplements should be added to a child’s diet to offset the harm that long-term antibiotics can cause?
My question comes from what’s been going on these past several months with my two-year-old son Griffin. He was sick for over two months, then we had tests to get through, and adjustment after that. We’re now, finally, after almost three months, getting back to normal.
A: The issue of prophylactic antibiotic use to prevent [future] UTIs has gone through much research, discussion, and reevaluation in the past few years. Once routine to give kids with a history of UTIs and grade I-III VUR, long-term (even lifelong) prophylactic medications, with a host of side effects including allergic reactions, photosensitivity, and abdominal complaints, this practice is no longer mainstream.
Studies with children who have a diagnosis of grades I-III VUR, (grades IV and V being most severe, and are not the subject here) have concluded that these children not only do not have increased risk of pyelonephritis (infection of the kidney)—as was previously assumed—but, antibiotic prophylaxis does not prevent recurrence of UTI, pyelonephritis (infection of the kidney, per se), or kidney scars.
Thus, UTI guidelines that had been routine and unquestioned for so long have been refigured. So, as with any controversial medical issue, seek second opinions—from qualified, “up to date” docs. Best of luck. I hope Griffin is doing well!
Family Health: Ask Dr. Rubin is published monthly. Each column features real questions from readers, and we invite other readers to respond with their thoughts and insights by posting comments. If you have a question for Dr. Mitchell Rubin, please send it to him care of the editor at firstname.lastname@example.org. Your question will be kept in the strictest of confidence.