P UTI X BEWARE DILATING VUR

 Non-dilating VUR does not predispose to UTI, acute pyelonephritis (APN), and renal parenchymal damage and urinary antibiotic prophylaxis is not routinely indicated in healthy children with non-dilating VUR. We still do no know if antibiotic prophylaxis will benefit those patients with severe (grades IV and V) VUR. There is only one large study that has attempted to answer this and it showed no beneficial effect in this select group but there was major concern that the reason for the absence of benefit was that the study was not sufficiently powered. We also do not know if antibiotic prophylaxis will benefit those patients presenting frequent recurrences of UTI especially APN? Currently there are no data available to resolve these two issues. It is only the more severe VUR in the pathogenesis of UTI, APN, and the use of urinary antibiotic prophylaxis needs to be explored further.