Primary prevention

The American Urological Association recommends antibiotic prophylaxis for children <1 year old with grade 3 to 5 vesicoureteral reflux (VUR) identified through screening, but no history of febrile UTI. Antibiotic prophylaxis may be considered for children with grade 1 to 2 VUR identified through screening, without a history of febrile UTI.[37]

Some experts recommend targeted antibiotic prophylaxis in patients with other anatomic urinary abnormalities.[38]

Secondary prevention

After a first UTI, it is recommended that patients' families and clinicians maintain a high index of suspicion for recurrent UTI.[4]

For children with bladder and bowel dysfunction (BBD), timed voiding every 2 hours during the day is helpful. Constipation is the main cause of voiding symptoms in children with BBD. Fecal disimpaction with enemas and laxatives should be followed by maintenance therapy with stool softeners such as polyethylene glycol to achieve soft, painless bowel movements.[19] Therapy may be required for months or years. 

A placebo-controlled randomized study analyzing the utility of cranberry products in preventing recurrent UTIs in children showed that, while it did not significantly reduce the number of children who experienced a recurrence of UTI, it was effective in reducing the actual number of recurrences and related antimicrobial use.[98] However, the compliance rate with chronic consumption of cranberry products was unsatisfactory. One meta-analysis demonstrated that probiotics are not effective in the secondary prevention of UTIs.[99]

The American Urological Association recommends antibiotic prophylaxis for children ages <1 year with vesicoureteral reflux (VUR) and a history of febrile UTI.[37] The use of antibiotic prophylaxis for children ages ≥1 year with VUR is determined on a case-by-case basis. Clinical context, including the presence of BBD, patient age, VUR grade, the presence of scarring, and parental preferences, should be taken into account. Prophylaxis is recommended for children with both VUR and BBD.[37] A short course of prophylactic antibiotics may be considered for toilet-trained children with BBD and recurrent UTIs, while optimizing bladder and bowel management.[19] Prophylaxis may also be considered in children with a major urologic anomaly.[37][38]

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