About 8% of girls and 2% of boys have had a urinary tract infection by the age of 7 years and around 5% of these suffer renal damage. Long-term antibiotic prophylaxis has been widely used but the evidence that it is effective is incomplete. Now a multicentre trial in Australia (New England Journal of Medicine 2009;361:1748–59’ see also Editorial, ibid:1804–6) has confirmed that prophylaxis with trimethoprim- sulfamethoxazole is modestly effective. A total of 576 children (median age 14 months, 77% <4 years old) who had had at least one urinary tract infection were randomised to trimethoprim-sulfamethoxazole suspension or placebo for 12 months. Vesicoureteric reflux had been demonstrated in 42% of the children. Further urinary tract infection occurred on treatment in 13% of the antibiotic group and 19% of the control group, a significant difference. The 6% absolute reduction in risk was consistent across all subgroups of patients including those with and without vesicoureteric reflux. Fourteen children would need to be treated to prevent one urinary tract infection. More trials are in progress in Sweden and the USA.

Social deprivation increases the risk of stillbirth or infant death. Smoking in pregnancy also increases these risks and is …