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Antibiotics for performing voiding cystourethrogram: a randomised control trial
  1. Rajiv Sinha1,2,
  2. Subhasis Saha1,
  3. Biplab Maji1,2,
  4. Yincent Tse3
  1. 1Paediatric Nephro-Urology unit, Advanced Medical Research Institute, Kolkata, West Bengal
  2. 2Paediatric Nephrology, Institute of Child Health, Kolkata, West Bengal, India
  3. 3Paediatric Nephrology, Great North Children Hospital, Newcastle, UK
  1. Correspondence to Dr Rajiv Sinha, 37, G Bondel Road, Kolkata, 700019, India; rajivsinha_in{at}yahoo.com

Abstract

Objective To assess whether antibiotic reduces voiding cystourethrogram (VCUG)-associated urinary tract infection (UTI).

Design Open-labelled randomised controlled trial.

Setting Tertiary paediatric nephrology centre.

Patients 120 children (age 2 months–5 years) undergoing VCUG.

Interventions Children were randomised into group A (antibiotic, n=72) or group B (no antibiotic, n=48) in 3:2 ratio. Group A received oral antibiotic (cephalexin if <6 months or co-trimoxazole if >6 months old) a day prior to VCUG and continued for 1 day post VCUG.

Main outcome measures The main outcome measure is incidence of VCUG-associated UTI. Urine was checked on day 3 after VCUG and UTI was defined as significant growth of a single organism in a symptomatic child.

Results The median age was 8 months (IQR 13 months) with 68% male. Indication for undertaking VCUG was history of UTI (first UTI in infancy=43, recurrent UTI=49) and congenital anomaly of kidney and urinary tract without any UTI (n=28). Post-VCUG UTI was significantly higher among group B in comparison to group A (17% (n=8) vs 1.4% (n=1); p=0.01, OR=14.2 (95% CI 1.7 to 117)). Multivariate binary logistic regression analysis found an abnormal pre-VCUG ultrasound scan to be a significant independent risk factor for post-VCUG UTI (p=0.02, OR=9.51, 95% CI 1.43 to 63.4). The number needed to treat with antibiotic to prevent one post-VCUG UTI was 6.5, which reduced to 4 if only the group with abnormal pre-VCUG ultrasound scan was included.

Conclusions Antibiotic significantly reduces post-VCUG-acquired UTI especially in those with abnormal ultrasound scans.

Trial registration number Clinical Trial Registry of India: CTRI/2017/03/00824.

  • nephrology
  • clinical procedures
  • imaging
  • therapeutics

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Footnotes

  • Contributors RS initiated the project, designed data collection tools, monitored data collection for the whole trial, drafted and revised the paper. He is the guarantor. SS, performed catheter insertion for VCUG and revised the draft paper. BM helped designed the study, randomised patients and revised the draft paper. YT wrote statistical analysis plan, analysed data, drafted and revised the paper. All authors approved the final paper.

  • Competing interests None declared.

  • Ethics approval AMRI IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data pertaining to this work are stored in the Institute of Child Health.

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