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Preventive UTI scripts questioned

By Emma Wilkinson

Long-term antibiotic prophylaxis in children with recurrent urinary tract infections may do more harm than good, Cochrane researchers have warned.

A review of current evidence found long-term antibiotic use did prevent some infections but caused too many adverse effects to justify treatment.

Nitrofurantoin in particular was associated with a range of adverse effects including nausea, vomiting and stomach ache.

Study leader Dr Gabrielle Williams, senior research officer at New Children's Hospital in Sydney, Australia, said there was not sufficient evidence to justify antibiotic prophylaxis.

She advised: 'Without evidence for a benefit, why use any prophylactic antibiotics? It may be that watchful waiting is a good option.'

But she admitted the lack

of evidence made it difficult

for doctors to make prescribing decisions, adding: 'We're currently running a big RCT, but results won't be available for a year or so.'

The reviewers identified three trials comparing antibiotics with placebo or no treatment over 10 weeks to 12 months.

Antibiotics reduced the risk of recurrent UTI by 36 per cent, but at a significant cost. In one study nitrofurantoin was more effective than trimethoprim but children were three times as likely to discontinue treatment because of side-effects.

Dr Anthony Harden, senior lecturer in the department of primary health care at the University of Oxford, said: 'The whole issue of UTIs in children is certainly of interest to GPs. Hygiene measures should come first but GPs should decide on an individual case-by-case basis as there will be one or two children who respond to antibiotics. '

Dr Harden, who is a GP in Wheatley, Oxfordshire, said: 'The interesting thing would be to look at different sub-groups of children.

'In children who have vesico-ureteric reflux there is no doubt they should be on prophylactic antibiotics ­ the benefits far outweigh the risks.'

Dr Chaand Nagpaul, member of the GPC prescribing sub-committee, said he did not believe it would be appropriate for GPs to alter current practice.

'There are serious consequences of untreated UTIs in young children in terms of kidney scarring ­ something I would want to protect the child against,' he added.

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