Does antibiotic prophylaxis prevent renal scarring in children with vesicoureteral reflux?

Antibiotic prophylaxis has been the recommended management for most children with vesicoureteral reflux and urinary tract infection (UTI). This Practice Point commentary discusses the study of Pennesi and colleagues, one of three recent randomized controlled clinical trials of children with reflux, which suggested that antibiotic prophylaxis might be unnecessary in this setting, as similar rates of febrile UTI and renal scarring were seen in individuals who received prophylaxis and those who did not. However, because follow-up was short in one study, UTI was diagnosed by bag samples in infants and toddlers in another, and, overall, an insufficient number of children at high risk for UTI were included in the analyses, the results should be treated with caution. Further evidence from large, double-blind trials will help to better define the role of prophylaxis in children with vesicoureteral reflux.