Download PDF
Kinder- und Jugendmedizin 2016; 16(05): 349-358
DOI: 10.1055/s-0037-1616336
Nephrologie
Schattauer GmbH

Antibakterielle Prophylaxe von Harnwegsinfektionen

Antibiotic prophylaxis for the prevention of urinary tract infections in children
R. Beetz
1   Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
› Author Affiliations
Further Information

Publication History

Eingereicht am: 19 May 2016

angenommen am 23 May 2016

Publication Date:
11 January 2018 (online)

    Permissions and Reprints

Zusammenfassung

Aktuelle prospektive, Placebo-kontrollierte Studien sprechen für eine Effektivität der antibakteriellen Infektionsprophylaxe gegenüber rezidivierenden Harnwegsinfektionen, insbesondere bei vesikorenalem Reflux im Kindesalter. Ein signifikanter Einfluss auf die Entwicklung frischer pyelonephritischer Nierenschädigungen konnte in diesen Studien nicht nachgewiesen werden.

Zu den Hauptindikationen für eine risikoorientierte antibakterielle Langzeit-Infektionsprophylaxe gehören der höhergradige vesikorenale Reflux (VUR), obstruktive Uropathien (z. B. obstruktiver Megaureter, Urethralklappen) und häufig rezidivierende, symptomatische HWI. Im Kindesalter zählen Nitrofurantoin, Trimethoprim und Cephalosporine zu den am meisten verwendeten Substanzen.

Die Prophylaxe darf sich nicht nur auf die Verordnung von antibakteriell wirksamen Medikamenten beschränken. Ebenso wichtig sind die Behandlung von Blasenfunktionsstörungen, Stuhlregulierung und die Beseitigung anderer prädisponierender Faktoren.

Es ist notwendiger denn je, die Indikationen für eine antibakterielle Prophylaxe kritisch zu überprüfen und diejenigen Kinder zu identifizieren, die einen eindeutigen Nutzen von einer längerfristigen antimikrobiellen Prophylaxe haben. Aktuelle Resistenzentwicklung, unerwünschte Nebenwirkungen von Chemotherapeutika und Akzeptanzprobleme erfordern die intensive Suche nach Alternativen in der Prophylaxe von Harnwegsinfektionen.

Summary

The results of current prospective, Placebo-controlled studies argue for an efficacy of antimicrobial prophylaxis in recurrent urinary tract infections, especially in children with vesicorenal reflux. However, a significant influence on pyelonephritic damages could not be proved.

Risk-oriented antibacterial prophylaxis is commonly used in symptomatic dilating VUR, in severe obstructive uropathies (i. e. urethral valve, obstructive megaureter) and in recurrent symptomatic UTIs. In infancy and childhood, Nitrofurantoin, Trimethoprim and Cephalosporines are prescribed most frequently. Prophylaxis should not be restricted to the use of antibiotics or other prophylactic agents but must also include the efficient management of bladder and/or bowel dysfunction, as well as the treatment of other predisposing factors.

To put antibacterial prophylaxis on its place, risk groups for recurrent symptomatic infections, ascending UTI and permanent renal damage have to be actually defined. The efficacy of prophylaxis in these groups has to be proved by further prospective randomized studies. Beyond that, current trends in bacterial resistance, adverse events with antibacterial substances and reducing acceptance necessitate more than ever clinical research in preventive alternatives.

Schlüsselwörter

Harnwegsinfektion - Pyelonephritis - antibakterielle Infektionsprophylaxe - Nierenparenchymschädigung - vesikoureteraler Reflux - Blasenfunktionsstörung

Keywords

Urinary tract infection - pyelonephritis - prophylaxis - renal damage - vesicoureteric reflux - bladder dysfunction
 

  • Literatur

  • 1 American Academy of Pediatrics CoQI, Subcommittee on Urinary Tract Infection. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics 2011; 128: 595-610.
    CrossrefPubMedGoogle Scholar
  • 2 Montini G, Hewitt I. Urinary tract infections: to prophylaxis or not to prophylaxis?. Pediatr Nephrol 2009; 24: 1605-1609.
    CrossrefPubMedGoogle Scholar
  • 3 Brandström P, Esbjörner E, Herthelius M. et al. The Swedish Reflux Trial in Children: III. Urinary Tract Infection Pattern. J Urol 2010; 184: 286-291.
    CrossrefPubMedGoogle Scholar
  • 4 Craig J. Antibiotic prophylaxis and recurrent urinary tract infection in children. New Engl J Med 2009; 361: 1748-1759.
    CrossrefPubMedGoogle Scholar
  • 5 Hoberman A, Greenfield SP, Mattoo TK. et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 2014; 370: 2367-2376.
    CrossrefPubMedGoogle Scholar
  • 6 Brandstrom P, Esbjorner E, Herthelius M. et al. The Swedish reflux trial in children: I. Study design and study population characteristics. J Urol 2010; 184: 274-279.
    CrossrefPubMedGoogle Scholar
  • 7 Hoberman A, Chesney RW. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 2014; 371: 1072-1073.
    PubMedGoogle Scholar
  • 8 Garin EH, Olavarria F, Garcia Nieto V. et al. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 2006; 117: 626-632.
    CrossrefPubMedGoogle Scholar
  • 9 Roussey-Kesler G, Gadjos V, Idres N. et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol 2008; 179: 674-679 discussion 9.
    PubMedGoogle Scholar
  • 10 Pennesi M, Travan L, Peratoner L. et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics 2008; 121: e1489-1494.
    CrossrefPubMedGoogle Scholar
  • 11 Montini G, Rigon L, Zucchetta P. et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics 2008; 122: 1064-1071.
    CrossrefPubMedGoogle Scholar
  • 12 Reddy P, Evans MT, Hughes PA. Antimicrobial prophylaxis with vesico-ureteral reflux: a randomized prospective study of continuous therpay vs. intermittent therapy vs. surveillance. Pediatrics 1997; 100 (Suppl): 555.
    Google Scholar
  • 13 de Bessa Jr J, de Carvalho Mrad FC, Mendes EF. et al. Antibiotic prophylaxis for prevention of febrile urinary tract infections in children with vesicoureteral reflux: a meta-analysis of randomized, controlled trials comparing dilated to nondilated vesicoureteral reflux. J Urol 2015; 193 (Suppl. 05) 1772-1777.
    CrossrefPubMedGoogle Scholar
  • 14 Fujinaga S, Kaneko K, Ohtomo Y. et al. Is continuous antibiotic prophylaxis in children with vesicoureteral reflux really ineffective in preventing pyelonephritis?. Pediatr Nephrol 2009; 24: 1431-1432.
    CrossrefPubMedGoogle Scholar
  • 15 Finnell SM, Carroll AE, Downs SM. Infection at-SoUT. Technical Report – Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children. Pediatrics 2011; 128: e749-e70.
    CrossrefPubMedGoogle Scholar
  • 16 Peters CA, Skoog SJ, Arant Jr BS. et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol 2010; 184: 1134-1144.
    CrossrefPubMedGoogle Scholar
  • 17 Tekgul S, Riedmiller H, Hoebeke P. et al. EAU guidelines on vesicoureteral reflux in children. Eur Urol 2012; 62: 534-542.
    CrossrefPubMedGoogle Scholar
  • 18 Shiraishi K, Yoshino K, Watanabe M. et al. Risk factors for breakthrough infection in children with primary vesicoureteral reflux. J Urol 2010; 183: 1527-1531.
    CrossrefPubMedGoogle Scholar
  • 19 Mingin GC, Nguyen HT, Baskin LS, Harlan S. Abnormal dimercapto-succinic acid scans predict an increased risk of breakthrough infection in children with vesicoureteral reflux. J Urol 2004; 172: 1075-1077 discussion 7.
    CrossrefPubMedGoogle Scholar
  • 20 Alconcher LF, Meneguzzi MB, Buschiazzo R, Piaggio LA. Could prophylactic antibiotics be stopped in patients with history of vesicoureteral reflux?. J Pediatr Urol 2009; 5: 383-388.
    CrossrefPubMedGoogle Scholar
  • 21 Moriya K, Mitsui T, Kitta T. et al. Early discontinuation of antibiotic prophylaxis in patients with persistent primary vesicoureteral reflux initially detected during infantile period: Outcome analysis and risk factors for febrile urinary tract infection. J Urol. 2014
    PubMedGoogle Scholar
  • 22 Al-Sayyad AJ, Pike JG, Leonard MP. Can prophylactic antibiotics safely be discontinued in children with vesicoureteral reflux?. J Urol 2005; 174 (04) (Suppl. 02) 1587-1589 discussion 9.
    CrossrefPubMedGoogle Scholar
  • 23 Thompson RH, Chen JJ, Pugach J. et al. Cessation of prophylactic antibiotics for managing persistent vesicoureteral reflux. J Urol 2001; 166: 1465-1469.
    CrossrefPubMedGoogle Scholar
  • 24 Cooper CS, Chung BI, Kirsch AJ. et al. The outcome of stopping prophylactic antibiotics in older children with vesicoureteral reflux. J Urol 2000; 163: 269-272 discussion 72–3.
    CrossrefPubMedGoogle Scholar
  • 25 Georgaki-Angelaki H, Kostaridou S, Daikos GL. et al. Long-term follow-up of children with vesicoureteral reflux with and without antibiotic prophylaxis. Scand J Infect Dis 2005; 37: 842-845.
    CrossrefPubMedGoogle Scholar
  • 26 Brandstrom P, Esbjorner E, Herthelius M. et al. The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol 2010; 184: 286-291.
    CrossrefPubMedGoogle Scholar
  • 27 Brandstrom P, Neveus T, Sixt R. et al. The Swedish reflux trial in children: IV. Renal damage. J Urol 2010; 184: 292-297.
    CrossrefPubMedGoogle Scholar
  • 28 Lee JH, Choi HS, Kim JK. et al. Nonrefluxing neonatal hydronephrosis and the risk of urinary tract infection. J Urol 2008; 179: 1524-1528.
    CrossrefPubMedGoogle Scholar
  • 29 Walsh TJ, Hsieh S, Grady R, Mueller BA. Antenatal hydronephrosis and the risk of pyelonephritis hospitalization during the first year of life. Urology 2007; 69: 970-974.
    CrossrefPubMedGoogle Scholar
  • 30 Song SH, Lee SB, Park YS, Kim KS. Is antibiotic prophylaxis necessary in infants with obstructive hydronephrosis?. J Urol 2007; 177: 1098-1101 discussion 101.
    CrossrefPubMedGoogle Scholar
  • 31 Coelho GM, Bouzada MC, Lemos GS. et al. Risk factors for urinary tract infection in children with prenatal renal pelvic dilatation. J Urol 2008; 179: 284-289.
    PubMedGoogle Scholar
  • 32 Gimpel C, Masioniene L, Djakovic N. et al. Complications and long-term outcome of primary obstructive megaureter in childhood. Pediatr Nephrol 2010; 25: 1679-1686.
    CrossrefPubMedGoogle Scholar
  • 33 Herndon CD. Antenatal hydronephrosis: differential diagnosis, evaluation, and treatment options. Scientific World Journal 2006; 6: 2345-2365.
    CrossrefPubMedGoogle Scholar
  • 34 Herndon CD, Kitchens DM. The management of ureteropelvic junction obstruction presenting with prenatal hydronephrosis. Scientific World Journal 2009; 9: 400-403.
    CrossrefPubMedGoogle Scholar
  • 35 Ulman I, Jayanthi VR, Koff SA. The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively. J Urol 2000; 164 (03) (Suppl. 02) 1101-1105.
    CrossrefPubMedGoogle Scholar
  • 36 Lichtenberger P, Hooton TM. Antimicrobial prophylaxis in women with recurrent urinary tract infections. Int J Antimicrob Agents 2011; 38 (Suppl): 36-41.
    CrossrefPubMedGoogle Scholar
  • 37 Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 1998; 160 (03) (Suppl. 02) 1019-1022.
    CrossrefPubMedGoogle Scholar
  • 38 Zegers B, Uiterwaal C, Kimpen J. et al. Antibiotic prophylaxis for urinary tract infections in children with spina bifida on intermittent catheterization. J Urol 2011; 186: 2365-2370.
    CrossrefPubMedGoogle Scholar
  • 39 Rawashdeh YF, Austin P, Siggaard C. et al. International Children‘s Continence Society‘s recommendations for therapeutic intervention in congenital neuropathic bladder and bowel dysfunction in children. Neurourol Urodyn 2012; 31: 615-620.
    CrossrefPubMedGoogle Scholar
  • 40 Bitsori M, Maraki S, Kalmanti M, Galanakis E. Resistance against broad-spectrum beta-lactams among uropathogens in children. Pediatr Nephrol. 2009
    PubMedGoogle Scholar
  • 41 Cheng CH, Tsai MH, Huang YC. et al. Antibiotic resistance patterns of community-acquired urinary tract infections in children with vesicoureteral reflux receiving prophylactic antibiotic therapy. Pediatrics 2008; 122: 1212-1217.
    PubMedGoogle Scholar
  • 42 Arya SC, Agarwal N, Agarwal S. Nitrofurantoin: an effective and ignored antimicrobial. Int J Antimicrob Agents 2006; 27: 354-355.
    CrossrefPubMedGoogle Scholar
  • 43 Kashanian J, Hakimian P, Blute Jr M. et al. Nitrofurantoin: the return of an old friend in the wake of growing resistance. BJU Int 2008; 102: 1634-1637.
    CrossrefPubMedGoogle Scholar
  • 44 Holmberg L, Boman G, Bottiger LE. et al. Adverse reactions to nitrofurantoin. Analysis of 921 reports. Am J Med 1980; 69: 733-738.
    CrossrefPubMedGoogle Scholar
  • 45 Coraggio MJ, Gross TP, Roscelli JD. Nitrofurantoin toxicity in children. Pediatr Infect Dis J 1989; 8: 163-166.
    PubMedGoogle Scholar
  • 46 Berger C. Diagnose und Behandlung von Harnwegsinfektionen beim Kind. Empfehlungen der Schweizerischen Arbeitsgruppe für Pädiatrische Nephrologie. Paediatrica 2013; 24: 10-13.
    Google Scholar
  • 47 Wagenlehner FM, Munch F, Pilatz A. et al. Urinary concentrations and antibacterial activities of nitroxoline at 250 milligrams versus trimethoprim at 200 milligrams against uropathogens in healthy volunteers. Antimicrob Agents Chemother 2014; 58: 713-721.
    CrossrefPubMedGoogle Scholar
  • 48 Hensle TW, Hyun G, Grogg AL, Eaddy M. Part 2: Examining pediatric vesicoureteral reflux: a real-world evaluation of treatment patterns and outcomes. Curr Med Res Opin 2007; 23 (Suppl. 04) S7-13.
    CrossrefPubMedGoogle Scholar
  • 49 Yiee JH, Baskin LS, Patel N. et al. Prospective blinded laboratory assessment of prophylactic antibiotic compliance in a pediatric outpatient setting. J Urol 2012; 187: 2176-2181.
    CrossrefPubMedGoogle Scholar
  • 50 Jernberg C, Lofmark S, Edlund C, Jansson JK. Long-term impacts of antibiotic exposure on the human intestinal microbiota. Microbiology 2010; 156 (Suppl. 11) 3216-3223.
    CrossrefPubMedGoogle Scholar
  • 51 Hellerstein S, Nickell E. Prophylactic antibiotics in children at risk for urinary tract infection. Pediatr Nephrol 2002; 17: 506-510.
    CrossrefPubMedGoogle Scholar
  • 52 Montini G, Hewitt I. Urinary tract infections: to prophylaxis or not to prophylaxis?. Pediatr Nephrol 2009; 24: 1605-1609.
    CrossrefPubMedGoogle Scholar
  • 53 Craig JC, Simpson JM, Williams GJ. et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 2009; 361: 1748-1759.
    PubMedGoogle Scholar
  • 54 Investigators TRt. Antimicrobial Prophylaxis for Children with Vesicoureteral Reflux. N Engl J Med. 2014
    PubMedGoogle Scholar
  • 55 Daschner F, Marget W. Treatment of recurrent urinary tract infection in children. II. Compliance of parents and children with antibiotic therapy regimen. Acta Paediatr Scand 1975; 64: 105-108.
    Google Scholar
  • 56 Westenfelder M, Vahlensieck W, Reinhartz U. Patient compliance and efficacy of low-dose, long-term prophylaxis in patients with recurrent urinary tract infection. Chemioterapia 1987; 6 (Suppl. 02) 530-532.
    PubMedGoogle Scholar
  • 57 Smyth AR, Judd BA. Compliance with antibiotic prophylaxis in urinary tract infection. Arch Dis Child 1993; 68: 235-236.
    CrossrefPubMedGoogle Scholar
  • 58 Copp HL, Nelson CP, Shortliffe LD. et al. Compliance with antibiotic prophylaxis in children with vesicoureteral reflux: results from a national pharmacy claims database. J Urol 2010; 183: 1994-1999.
    CrossrefPubMedGoogle Scholar