Antimicrobial Prophylaxis for Children with Vesicoureteral Reflux
Michael Epstein
Avram Z. Traum
Antimicrobial Prophylaxis for Children With Vesicoureteral Reflux
RIVUR (Randomized Intervention for Children With Vesicoureteral Reflux) Trial Investigators, Hoberman A, Greenfield SP, et al. N Engl J Med. 2014;370(25):2367–2376
Background
Vesicoureteral reflux (VUR) is present in 1/3 of children with febrile urinary tract infections (UTI) and is a known risk factor for recurrent infections. UTIs and reflux can lead to renal scarring and chronic kidney disease, also known as reflux nephropathy. Despite this, data on efficacy of antibiotic prophylaxis in VUR were inconsistent and scarce. RIVUR was the first large trial with rigorous methodology to attempt establishment of an evidence-based standard of care.
Objectives
To determine the efficacy of long-term antibiotic prophylaxis in preventing UTI recurrence and renal scarring in children with VUR.
Methods
Double-blind, randomized, placebo-controlled trial in 19 US centers from 2007 to 2011.
Patients
607 children ages 2 to 71 months with grade I–IV VUR diagnosed after a first or second UTI. Select exclusion criteria: other urologic anomalies.
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