Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group
Emilia-Romagna Pediatric UTI Network · 2023 · Italy
Source and licence
- Authors
- Giovanni Autore, Luca Bernardi, Filippo Ghidini et al.
- Title
- Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group
- Journal
- Antibiotics, 2023
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10295299
Licence statement of the original publication
Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
3.1. Should Continuous Antibiotic Prophylaxis Be Used in All Children with a Previous UTI?
- Recommendation 1Continuous antibiotic prophylaxis is not routinely indicated in all children after the first episode of UTIstrong recommendation against the intervention; evidence quality: moderate
- Clinical guidelines published by the Italian Society for Pediatric Nephrology (SINePe) and the Kidney Health Australia/Caring for Australians and New Zealanders with Renal Impairment (KHA/CARI) and the Swiss consensus recommendations suggest against the routine use of CAP (Grade A) [32,33,34] [Table S4].
3.2. Should Continuous Antibiotic Prophylaxis Be Used in All Children with a History of Recurrent UTIs?
- Recommendation 2A history of recurrent UTIs without underlying urological anomalies does not constitute a sufficient indication for continuous antibiotic prophylaxisweak recommendation against the intervention; evidence quality: low
3.3. Should Continuous Antibiotic Prophylaxis Be Used in All Children with VUR of Any Grade?
- Recommendation 3Continuous antibiotic prophylaxis is not recommended for children with low-grade (I–II) or non-dilating VURstrong recommendation against the intervention; quality of evidence: moderate
3.4. Should Continuous Antibiotic Prophylaxis Be Used in All Children with High-Grade VUR (III–V)?
- Recommendation 4Considering the lack of effect of the antibiotic prophylaxis on the risk of renal scarring, continuous antibiotic prophylaxis is not routinely recommended in children with high-grade (III–IV) or dilating VURweak recommendation against the intervention; quality of evidence: moderate
3.5. Should Antibiotic Prophylaxis Be Used in Children with Isolated Hydronephrosis?
- Recommendation 5Continuous antibiotic prophylaxis is not routinely recommended in children with isolated antenatal or postnatal hydronephrosis or ureteropelvic junction obstructionweak recommendation against the intervention; quality of evidence: low
3.6. Should Antibiotic Prophylaxis Be Used in Children with Intravesical Obstructions (i.e., Urethral Valves)?
- Recommendation 6There is no sufficient evidence to define efficacy and safety of continuous antibiotic prophylaxis in children with infravesical obstructions.
3.7. Should Antibiotic Prophylaxis Be Used in Children with Hydroureteronephrosis (i.e., Primary Obstructive Megaureter)?
- Recommendation 7Continuous antibiotic prophylaxis may be considered in children with hydroureteronephrosis and ureteral dilation > 7 mm or primary obstructive megaureterweak recommendation for the intervention; quality of evidence: low
3.8. Should Antibiotic Prophylaxis Be Used in Children with Neurogenic Bladder?
- Recommendation 8Continuous antibiotic prophylaxis is not routinely recommended in children affected by neurogenic bladderweak recommendation against the intervention; quality of evidence: low
3.9. Which Antibiotic Should Be Preferred for Long-Term Prophylaxis of UTI in Children?
- Recommendation 9There is insufficient evidence to recommend trimethoprim–sulfamethoxazole rather than nitrofurantoin as the first-choice prophylactic antibiotic.
3.10. Should the Prophylactic Antibiotic Be Changed after a Breakthrough UTI in Children already on Prophylaxis?
- Recommendation 10There is insufficient evidence to recommend changing the prophylactic antibiotic after a breakthrough UTI in children already on prophylaxisweak recommendation; quality of evidence: very low
3.11. Which Dosage Should Be Preferred for Continuous Antibiotic Prophylaxis?
- Recommendation 11There is insufficient evidence to recommend a specific dose for continuous antibiotic prophylaxis.
3.12. Should Antibiotic Prophylaxis Be Continued in Children Undergoing Pyeloplasty?
- Recommendation 12In the absence of other persistent risk factors, antibiotic prophylaxis may be discontinued after pyeloplastyweak recommendation against the intervention; quality of evidence: very low
3.13. How Long Should Antibiotic Prophylaxis Be Continued in Children Undergoing Ablation of Posterior Urethral Valves?
- Recommendation 13There is insufficient evidence to recommend how long antibiotic prophylaxis should be continued after ablation of posterior urethral valves.
3.14. How Long Should Antibiotic Prophylaxis Be Continued in Children Undergoing Ureteral Reimplantation?
- Recommendation 14There is insufficient evidence to recommend how long antibiotic prophylaxis should be continued after ureteral reimplantation.
3.15. How Long Should Antibiotic Prophylaxis Be Continued in Children Undergoing Endoscopic Treatment of VUR?
- Recommendation 15There is insufficient evidence to recommend how long antibiotic prophylaxis should be continued in children undergoing endoscopic treatment of VUR. According to recommendations 3 and 4, antibiotic prophylaxis is not recommended in children with VUR of any grade.
5. Conclusions
- Short-term prophylaxis may be considered until the exclusion of urological anomalies.Strength and Quality: Weak recommendation for the intervention.Expert opinion
- Close surveillance based on early diagnosis (i.e., urinalysis and urine culture) and prompt antibiotic therapy in symptomatic/febrile children may be considered in children with VUR of any grade.Strength and Quality: Weak recommendation.Expert opinion
- Considering the lack of effect of antibiotic prophylaxis on the risk of renal scarring, continuous antibiotic prophylaxis is not routinely recommended in children with high-grade (III–IV) or dilating VUR.Strength and Quality: Weak recommendation against the intervention.Evidence quality: B
- Close surveillance based on early diagnosis (i.e., urinalysis and urine culture) and prompt antibiotic therapy in symptomatic/febrile children is recommended in children with VUR of any grade.Strength and Quality: Weak recommendation.Expert opinion
- There is no sufficient evidence to define the efficacy and safety of continuous antibiotic prophylaxis in children with infravesical obstructions.Continuous antibiotic prophylaxis may be considered until surgical correction.Strength and Quality: Weak recommendation for the intervention. Expert opinion
- Proper execution of clean intermittent catheterization and close surveillance, based on early diagnosis (i.e., urinalysis and urine culture) and prompt antibiotic therapy in symptomatic/febrile children, may be considered in children with neurogenic bladder.Strength and Quality: Weak recommendation.Expert opinion
- There is insufficient evidence to recommend trimethoprim–sulfamethoxazole rather than nitrofurantoin as the first-choice prophylactic antibiotic.There is no evidence on the efficacy and safety of amoxicillin–clavulanic acid as a prophylactic antibiotic to prevent UTIs.The prophylactic use of oral cephalosporins is not suggested due to the high risk of new antimicrobial resistancesStrength and Quality: Weak recommendation against the intervention.Evidence quality: C
- There is insufficient evidence to recommend a specific dose for continuous antibiotic prophylaxis.Doses from one-quarter to one-third of the standard treatment dosage may be appropriateStrength and Quality: Weak recommendation.Expert opinion
- There is insufficient evidence to recommend how long antibiotic prophylaxis should be continued in children undergoing endoscopic treatment of VUR.According to recommendations 3 and 4, antibiotic prophylaxis is not routinely recommended in children with VUR of any grade.
Abstract
Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. Methods: A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results: The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended. Conclusions: Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk.
Contents of the original publication
The section headings of the original.
- 1. Introduction
- 2. Materials and Methods
- 2.1. Clinical Question
- 2.2. Search Strategy and Eligibility Criteria
- 2.3. Risk of Bias and Methodological Quality Assessment
- 2.4. Data Extraction and Synthesis
- 3. Results
- 3.1. Should Continuous Antibiotic Prophylaxis Be Used in All Children with a Previous UTI?
- 3.2. Should Continuous Antibiotic Prophylaxis Be Used in All Children with a History of Recurrent UTIs?
- 3.3. Should Continuous Antibiotic Prophylaxis Be Used in All Children with VUR of Any Grade?
- 3.4. Should Continuous Antibiotic Prophylaxis Be Used in All Children with High-Grade VUR (III–V)?
- 3.5. Should Antibiotic Prophylaxis Be Used in Children with Isolated Hydronephrosis?
- 3.6. Should Antibiotic Prophylaxis Be Used in Children with Intravesical Obstructions (i.e., Urethral Valves)?
- 3.7. Should Antibiotic Prophylaxis Be Used in Children with Hydroureteronephrosis (i.e., Primary Obstructive Megaureter)?
- 3.8. Should Antibiotic Prophylaxis Be Used in Children with Neurogenic Bladder?
- 3.9. Which Antibiotic Should Be Preferred for Long-Term Prophylaxis of UTI in Children?
- 3.10. Should the Prophylactic Antibiotic Be Changed after a Breakthrough UTI in Children already on Prophylaxis?
- 3.11. Which Dosage Should Be Preferred for Continuous Antibiotic Prophylaxis?
- 3.12. Should Antibiotic Prophylaxis Be Continued in Children Undergoing Pyeloplasty?
- 3.13. How Long Should Antibiotic Prophylaxis Be Continued in Children Undergoing Ablation of Posterior Urethral Valves?
- 3.14. How Long Should Antibiotic Prophylaxis Be Continued in Children Undergoing Ureteral Reimplantation?
- 3.15. How Long Should Antibiotic Prophylaxis Be Continued in Children Undergoing Endoscopic Treatment of VUR?
- 4. Discussion
- 5. Conclusions
- Supplementary Materials
- Institutional Review Board Statement
- Informed Consent Statement
A question about this guideline?
Medelix answers clinical questions from guidelines and studies – every statement with its source.
Are you the rights holder and object to this reproduction? Write to contact@medelix.ai and we will take the page down promptly. Imprint