Prophylaxis Options in Children With a History of Recurrent Urinary Tract Infections: A Systematic Review.

IF 6.2 2区 医学 Q1 PEDIATRICS
Nikolaos Gkiourtzis, Anastasia Stoimeni, Agni Glava, Sofia Chantavaridou, Panagiota Michou, Konstantinos Cheirakis, Alexander D Lalayiannis, Sally A Hulton, Despoina Tramma
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Abstract

Context: The prevention of urinary tract infection recurrence (UTI) in children has been a challenge yet to be solved. Current practice in children with recurrent UTI (RUTI) suggests that antibiotic prophylaxis may prevent further episodes of UTI and future complications.

Objective: To conduct a systematic review and meta-analysis of randomized controlled trials comparing prophylaxis options for the prevention of UTI and kidney scarring in children with a history of RUTI.

Data sources: We conducted a systematic literature search through major electronic databases (PubMed/Medline, Scopus and Cochrane Library) up to November 26th, 2023. Mean difference and SD were used for continuous outcomes and odds ratio for dichotomous outcomes.

Study selection: Our meta-analysis included 3335 participants from 23 studies.

Data extraction: The primary outcome was the effect of the different prophylaxis options on the incidence of symptomatic UTI in children with RUTI during prophylactic treatment.

Results: Cranberry products and nitrofurantoin lead to lower odds of symptomatic UTI episodes during prophylaxis compared with the control group and control, trimethoprim-sulfamethoxazole, or trimethoprim groups accordingly. Nitrofurantoin may be the best option for UTI incidence reduction compared with all available documented interventions.

Limitations: No prophylaxis option has been shown to reduce kidney scarring.

Conclusions: Nitrofurantoin and cranberry products may decrease the incidence of symptomatic UTI episodes in pediatric patients with a history of RUTI. Future randomized control trials studying nonantibiotic prophylaxis options focusing on children with UTI recurrence and the risk for kidney scarring are needed to draw further conclusions.

有复发性尿路感染病史的儿童的预防方案:系统回顾
背景:预防儿童尿路感染复发(UTI)一直是一项尚未解决的难题。目前对复发性尿路感染(UTI)患儿的治疗表明,抗生素预防可防止UTI的再次发作和未来并发症的发生:目的:对随机对照试验进行系统综述和荟萃分析,比较有 RUTI 病史的儿童预防 UTI 和肾脏瘢痕的各种方案:我们通过主要电子数据库(PubMed/Medline、Scopus 和 Cochrane Library)进行了系统性文献检索,截至日期为 2023 年 11 月 26 日。连续性结果采用平均差和标度,二分法结果采用几率比:我们的荟萃分析包括 23 项研究的 3335 名参与者:主要结果是不同预防方案对预防性治疗期间RUTI患儿症状性UTI发生率的影响:蔓越莓产品和硝基呋喃妥因与对照组、对照组、三甲氧苄啶-磺胺甲噁唑组或三甲氧苄啶组相比,可降低预防治疗期间症状性UTI发作的几率。与所有有记录的干预措施相比,硝基呋喃妥因可能是降低UTI发病率的最佳选择:局限性:没有任何一种预防方案能减少肾脏瘢痕的形成:结论:硝基呋喃妥因和蔓越莓产品可降低有 RUTI 病史的儿科患者症状性 UTI 的发病率。未来需要开展随机对照试验,研究非抗生素预防方案,重点关注UTI复发儿童和肾脏瘢痕风险,以得出进一步结论。
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来源期刊
Pediatrics
Pediatrics 医学-小儿科
CiteScore
12.80
自引率
5.00%
发文量
791
审稿时长
2-3 weeks
期刊介绍: The Pediatrics® journal is the official flagship journal of the American Academy of Pediatrics (AAP). It is widely cited in the field of pediatric medicine and is recognized as the leading journal in the field. The journal publishes original research and evidence-based articles, which provide authoritative information to help readers stay up-to-date with the latest developments in pediatric medicine. The content is peer-reviewed and undergoes rigorous evaluation to ensure its quality and reliability. Pediatrics also serves as a valuable resource for conducting new research studies and supporting education and training activities in the field of pediatrics. It aims to enhance the quality of pediatric outpatient and inpatient care by disseminating valuable knowledge and insights. As of 2023, Pediatrics has an impressive Journal Impact Factor (IF) Score of 8.0. The IF is a measure of a journal's influence and importance in the scientific community, with higher scores indicating a greater impact. This score reflects the significance and reach of the research published in Pediatrics, further establishing its prominence in the field of pediatric medicine.
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