Pediatric Vesicoureteral Reflux Medication

Updated: Jul 09, 2020
  • Author: Caleb P Nelson, MD, MPH; Chief Editor: Marc Cendron, MD  more...
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Medication

Antibiotics

Class Summary

These are used for maintenance of sterile urine. Antibiotic agents used for prophylaxis in children with vesicoureteral reflux (VUR) are chosen for their efficacy in the urinary tract, safety, and tolerability. The typical dose is one fourth of the therapeutic dose. They are usually administered as suspensions once daily, typically in the evening to maximize overnight drug levels in the bladder. In neonates with antenatally diagnosed hydronephrosis and in infants younger than 8 weeks who have been treated for urinary tract infection (UTI), the agent of choice is amoxicillin. For older children, the most common antibiotics used are trimethoprim-sulfamethoxazole, nitrofurantoin, and penicillins. The cephalosporins are used less often.

Amoxicillin (Amoxil, Biomox, Trimox)

Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria. Is generally well tolerated, although has a higher rate of fecal resistance than some other agents. Metabolized effectively by newborns, making it a good choice for neonates.

Sulfamethoxazole and trimethoprim (Bactrim, Septra, Cotrim)

Inhibit bacterial growth by inhibiting synthesis of dihydrofolic acid. DOC in children >6-8 wk. The maturing hepatobiliary system is able to process trimethoprim-sulfamethoxazole combination agents, which have an excellent urinary concentration profile and tend to cause fewer fecal resistance problems. Well tolerated orally.

Nitrofurantoin (Furadantin, Macrodantin)

Synthetic nitrofuran that interferes with bacterial carbohydrate metabolism by inhibiting acetylcoenzyme A. Bacteriostatic at low concentrations (5-10 mcg/mL) and bactericidal at higher concentrations.

Another common urinary antiseptic agent for children >8 wk. Unpleasant taste of the liquid form makes it unacceptable to some children. Older children who can tolerate tablets do well with this medication.