Routine prophylaxis is not necessary to prevent renal scarring in children with urinary tract infection.

Commentary on:  Hewitt IK, Pennesi M, Morello W, et al . Antibiotic prophylaxis for urinary tract infection-related renal scarring: a systematic review. Pediatrics 2017;139:e20163145. Renal scarring is a potentially serious long-term complication of acute pyelonephritis, and the risk increases significantly in children with high-grade vesicoureteral reflux (VUR) and recurrent urinary tract infection (UTI).1 For decades it has been a common practice to use antimicrobial prophylaxis or surgical correction to prevent recurrent UTI and renal scarring in children with VUR. Some recent studies have shown that antimicrobial prophylaxis significantly decreases the risk of UTI recurrence in children with VUR but does not significantly impact the risk of renal scarring when compared with placebo or no treatment.2 3 A review of the literature and a meta-analysis were done …