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Wednesday, April 23, 2014
Urinary and Genital Disorders (Children)
Grade II Vesicoureteral Reflux
My daughter is 3 months old and just got diagnosed with Grade II Vesicoureteral Reflux. I was told that she doesn`t need to be on any antibiotics but I`m nervous that the UTI`s will return. Everything that I`m reading on the internet tells me that children are on a low grade antibiotic. Are there ways to keep from getting the UTI`s?
This topic is controversial. Ten years ago standard therapy would have been to prescribe a low dose of an antibiotic ("prophylaxis"). However, three recent studies have suggested that prophylaxis may be unnecessary in children with low grade reflux; in other words, the likelihood of a UTI is not reduced by prescribing prophylaxis. The problem is that babies less than one year who develop a kidney infection are more likely to develop kidney damage compared to older children.
The most prudent approach at this time would be to monitor her off prophylaxis for the time being. If she develops a significant fever, then she should be examined by her doctor, and a urine culture should be obtained. If she develops another UTI, then a change in management should be considered.
Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University