Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials
- 1Centre for Kidney Research and Cochrane Renal Group, NHMRC Centre of Clinical Research Excellence in Renal Medicine, The Children’s Hospital at Westmead, Sydney, Australia
- 2Department of Urology, The Children’s Hospital at Westmead, Sydney, Australia
- 3School of Public Health, University of Sydney, Australia
- Correspondence to:
Associate Professor J Craig, Centre for Kidney Research, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia;
- Accepted 11 March 2003
Aims: To evaluate the benefits and harms of treatments for vesicoureteric reflux in children.
Methods: Meta-analyses of randomised controlled trials using a random effects model. Main outcome measures were incidence of urinary tract infection (UTI), new or progressive renal damage, renal growth, hypertension, and glomerular filtration rate.
Results: Eight trials involving 859 evaluable children comparing long term antibiotics with surgical correction of reflux (VUR) and antibiotics (seven trials) and antibiotics compared with no treatment (one trial) were identified. Risk of UTI by 1–2 and 5 years was not significantly different between surgical and medical groups (relative risk (RR) by 2 years 1.07; 95% confidence interval (CI) 0.55 to 2.09, RR by 5 years 0.99; 95% CI 0.79 to 1.26). Combined treatment resulted in a 60% reduction in febrile UTI by 5 years (RR 0.43; 95% CI 0.27 to 0.70) but no concomitant significant reduction in risk of new or progressive renal damage at 5 years (RR 1.05; 95% CI 0.85 to 1.29). In one small study no significant differences in risk for UTI or renal damage were found between antibiotic prophylaxis and no treatment.
Conclusion: It is uncertain whether the identification and treatment of children with VUR confers clinically important benefit. The additional benefit of surgery over antibiotics alone is small at best. Assuming a UTI rate of 20% for children with VUR on antibiotics for five years, nine reimplantations would be required to prevent one febrile UTI, with no reduction in the number of children developing any UTI or renal damage.
- systematic review
- randomised controlled trial
- vesicoureteric reflux
- urinary tract infection