Understanding and Managing Pediatric Urinary Tract Infections in Vesicoureteral Reflux: Insights Into Pathophysiology and Care

Abstract

Vesicoureteral reflux (VUR) is a pediatric condition identified by the backward flow of urine from the bladder to one or both ureters and kidneys, predisposing patients to recurrent urinary tract infections (UTIs) and kidney scarring. Continuous antibiotic prophylaxis has long been a mainstay of management aimed at preventing recurrent UTIs and resulting renal damage. This review critically discusses the evidence supporting the utilization of antibiotic prophylaxis in VUR, with a focus on its efficacy, safety, long-term outcomes, and future directions in management. The literature reveals that continuous antibiotic use as a prophylactic measure minimizes the possibility of having recurrent UTIs in VUR children, especially in high-grade reflux children. However, the overall benefit of continuous antibiotic prophylaxis in protecting against kidney scarring remains controversial. Furthermore, concerns about antibiotic resistance, adverse drug reactions, and the psychosocial burden on families have led to a reevaluation of this option's role in managing VUR. Emerging evidence supports the role of non-antibiotic interventions and the potential of surgical management in select cases. Future research should focus on identifying criteria of patients who would benefit most from continuous antibiotic prophylaxis and on developing novel therapeutic approaches to minimize the need for prolonged antibiotic use.

Keywords: continuous antibiotic prophylaxis; cost-effectiveness; pediatric; urinary tract infection; vesicoureteral reflux.

Figure 1. Grades of vesicoureteral reflux (VUR).

This figure is original and created by the authors.