Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jun 26, 2015; 5(2): 13-19
Published online Jun 26, 2015. doi: 10.5662/wjm.v5.i2.13
Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics
Kishor Tewary, Hassib Narchi
Kishor Tewary, Department of Pediatrics, University Hospitals of North Midlands, Stoke-on-Trent, ST4 6QG Staffordshire, United Kingdom
Hassib Narchi, Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, PO Box 17666, United Arab Emirates
Author contributions: Tewary K and Narchi H had made substantial contributions to the conception and design of the editorial, drafting the article or making critical revisions related to important intellectual content of the manuscript and final approval of the version of the article to be published.
Conflict-of-interest: The authors have no commercial, personal, political, intellectual, or religious conflict-of-interest to report in relation to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hassib Narchi, MD, FRCPCH, Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, PO Box 17666, United Arab Emirates. hassib.narchi@uaeu.ac.ae
Telephone: +971-37-137414 Fax: +971-37-672022
Received: January 19, 2015
Peer-review started: January 20, 2015
First decision: February 7, 2015
Revised: March 3, 2015
Accepted: April 16, 2015
Article in press: April 20, 2015
Published online: June 26, 2015
Abstract

Urinary tract infection (UTI) is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through infections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to find a safer, effective and acceptable alternative. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vaccinium Macrocarpon (cranberry), commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus (LA-5) and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli (E. coli) 83972 has resulted in subjective benefit and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions, other than antibiotic prophylaxis, for the prevention of recurrent UTI have been tried and, although showing some promise, they do not provide so far a definitive effective answer. Finding suitable alternatives still requires further high quality research of those seemingly promising interventions.

Keywords: Kidney, Recurrence/prevention, Urinary tract infections, Vesico-ureteral reflux, Vaccinium macrocarpon, Circumcision, Vaccination, Constipation, Lactobacillus

Core tip: Antibiotic prophylaxis against urinary tract infection recurrences is associated with adverse drug reaction and development of resistance. Although showing some promise, alternative interventions, such as Vaccinium Macrocarpon (cranberry), Lactobacillus and Probiotics, circumcision, surgical management of vesicoureteral reflux, deliberate colonization of the urinary tract with Escherichia-coli (E. coli) 83972, treating constipation and dysfunctional voiding, administration of synthetic substitutes that reproduce natural surface glycosaminoglycan(s) anti-adherence effect on uroepithelial cells and E. coli isolate NU14 DeltawaaL as a candidate for developing a live-attenuated vaccine, do not provide so far a definitive effective answer. Further high quality research is still required.