Outcome of Antibiotic Prophylaxis Cessation in Patients With Persistent Vesico-Ureteral Reflux Who Initially Presented With a Febrile Urinary Tract Infection

PurposeGrowing evidence suggests that antibiotic prophylaxis (ABP) may not prevent urinary tract infections (UTI). We report on the outcome of a specific cohort of patients assembled based on initial VUR diagnosis after a febrile UTI.Material and MethodsWe retrospectively reviewed a prospectively collected database of patients with persistent VUR who discontinued ABP once toilet trained and with no evidence of dysfunctional voiding. End points included febrile UTIs, abnormalities on follow-up renal ultrasound and need for further interventions.Results72 girls and 24 boys were evaluated. Mean patient age at ABP cessation was 5.4 years (range 2.3-11.8), and mean subsequent follow-up was 28months (range 5-101). Reflux grade at presentation was I in 3%, II in 37%, III in 46%, IV in 8% and V in 4%; VUR was bilateral in 51 patients (53%). Febrile urinary tract infection developed in 9 girls and 1 boy (10% of the cohort, mean age=6 years), an average of 17.2 months (range 5 to 44 months) after ABP discontinuation. Findings consistent with new renal scarring on ultrasound were identified in one patient who developed a febrile UTI and in one without infection. Upon comparison of the group who developed febrile UTI against those that did not a significant difference was found in number of high grade VUR (p 0.007) and the development of dysfunctional voiding (p=0.002).ConclusionsThis data supports ABP discontinuation in the majority of patients with VUR who present with a febrile UTI. Development of dysfunctional elimination symptoms seems to be a preventable risk factor amenable to treatment.