Effects of Antibiotic Prophylaxis on Recurrent UTI in Children
Condition: Urinary Tract Infection; Recurrent Urinary Tract Infection
MeSH terms: Infections; Communicable Diseases; Urinary Tract Infections; Recurrence
Intervention: Antibiotic Prophylaxis
Intervention description: Approved clinical dosage or antibiotics
Intervention MeSH terms: Anti-Bacterial Agents
Phase: Phase 4
Study type: Interventional
Primary purpose: Basic Science
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 59.0
Sex: All
Minimum age: 3 Years
Maximum age: 15 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: Antibiotic Prophylaxis; Urinary Microbiota

Summary:

      Approximately, 3% of males and 8% of females will develop a urinary tract infection (UTI)
      during childhood, and most of these will be effectively treated by short-term antibiotic
      therapy. A subset of these children (20-48%), will develop recurrent UTI (RUTI), which may
      have long-term effects in the form of hypertension or renal damage.

      In an effort to prevent RUTIs physicians prescribe sulfamethoxazole-trimethoprim (Septra) or
      nitrofurantoin as low dose antibiotic prophylaxis. However, recent evidence suggests that
      during prophylactic therapy the body is exposed to antibiotic levels capable of increasing
      antibiotic resistance and bacterial virulence. This has been shown to be true in the
      uropathogens E. coli and Staphylococcus saprophyticus, yet it is not known if Enterococcus
      sp. demonstrate similar mechanisms. Additionally, antibiotics have been shown to disrupt the
      natural balance of the human microbiome, potentially leading to major long term problems.

      As a uropathogen, enterococci consistently rank in the top 3 causes of RUTI, especially in
      children under 3 years of age. Additionally, Enterococcus is notorious for developing
      antibiotic resistance and studies have shown that children with enterococcal UTIs exhibit a
      higher rate of recurrence than those with non-enterococcal UTIs.

      The investigators hypothesize the current practice of antibiotic prophylaxis in children with
      RUTI is detrimental and can change the bacterial and sensitivity profiles of these patients.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patient has experienced a minimum of 2 UTIs within the last year, as well as a culture
             proven UTI for inclusion into either of the RUTI groups.

          -  Patients must be deemed to require antibiotic prophylaxis, at the discretion of Dr.
             Dave and following the standard of care, for inclusion in the antibiotic prophylaxis
             group.

          -  Patients with no known urological abnormalities, recent history of UTI or antibiotic
             use are eligible for inclusion in the healthy patient group.

        Exclusion Criteria:

          -  Patients with an abnormal urinary tract as determined through the use of ultrasound
             and, given an abnormal ultrasound, or greater than two febrile UTIs, a voiding
             cystourethrogram (VCUG). The use of both ultrasound and VCUG given these indications
             is standard of care.