Effective management of urinary tract infection and vesicoureteric reflux: the Cochrane perspective

EM Hodson

Centre for Kidney Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia

Introduction and methods. Systematic reviews of randomised controlled trials (RCTs) of interventions in urinary tract infection (UTI) and vesicoureteric reflux (VUR) can provide a basis for decisions on therapies and for planning new research. The Cochrane Collaboration produces and maintains systematically prepared reviews of research evidence from RCTs on interventions in all health areas.
Results. Five reviews and protocols on UTI and VUR are published in the Cochrane Library. A review of 10 trials of short (2-4 days) compared with standard duration therapy (7-14 days) found no difference in persisting UTI or recurrence. However pyelonephritis was excluded and symptomatic UTIs, the outcomes of most interest, were not differentiated from asymptomatic UTIs. A review of 5 studies of long term antibiotics to prevent UTI found no clear evidence to support the current practice of using long term antibiotic prophylaxis to prevent UTI in children with VUR because studies were not designed to address this and/or did not include young children with VUR. A review of 5 trials of interventions for primary VUR showed no benefit of surgery and antibiotics compared with antibiotics alone in risk of UTI, new or further renal damage. However no studies were found which compared no therapy with any therapy so we still need information on whether any therapy is effective in preventing new or progressive renal damage. Two reviews found no reliable evidence (4 trials) that cranberries prevent UTI and no RCTs on treating UTI with cranberries.
Conclusions. Systematic reviews on UTI and VUR in children have revealed a paucity of well performed RCTs on which to base treatment decisions. The findings provide paediatric nephrologists with the incentive to set up well designed and adequately powered RCTs to determine the treatment regimens which provide the best outcomes in terms of benefits and harms for children with UTI and/or VUR.

Presented at the 12th Congress of the International Paediatric Nephrology Association, Seattle, September 2001

Correspondence
Elisabeth Hodson
ElisaH@chw.edu.au