방광요관역류에서 예방적 항생제요법의 최신 지견

Abstract

Antibiotic prophylaxis has been administered to prevent acute pyelonephritis and renal scar development in children with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTI) since the 1960s. However, randomized clinical trials, systematic reviews and meta-analyses on antibiotic prophylaxis after UTI has been published in the last 5 years demonstrate not only ineffective routine antimicrobial prophylaxis in patients with low-grade VUR is ineffective in reducing recurrent UTI, but also antimicrobial resistant rate actually increased. Because children with high-grade VUR were excluded in most of these studies, these findings cannot be applied to grade IV-V VUR. Furthermore, debatable results regarding benefits of antimicrobial prophylaxis in grade III reflux has been reported. The on-going Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) study will provide useful data to address this problem.