Options of modern anti-relapse therapy for urinary tract infections in children: CRUTIL trial

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D.D. Ivanov
T.P. Ivanova
O.G. Fedorenko
S.V. Kushnirenko
M.D. Ivanova


Background. Recurrent urinary tract infection (UTI) is a serious problem in pediatric nephrology, affecting the qua­lity of life and increasing the burden on the health system. Consi­deration of individual factors and the development of approaches to anti-relapse therapy, especially in children without apparent objective reasons for the relapse of infection, is an urgent task. Materials and methods. A prospective, multicentre, randomized, parallel-group, open-label CRUTIL (Children’s Recurrent Urinary Tract Infections on bacterial Lysate) study was conducted, it included 83 children aged 3 to 15 years (8.0 ± 2.2 years) with recurrent UTI. The children were randomized into 3 groups: the first one — 22 patients who received supplementary therapy with Urivac lysate, the second one — 28 children who received supplementary therapy with Uro-Vaxom lysate, and the third group (controls) — 33 patients who received standard therapy. Duration of immunoactive therapy was 6 months, patients of these groups also received anti-relapse treatment with a single dose of urinary antiseptic at bedtime for 18 months; follow-up was 24 months. Results. In the first group of children who received Urivac, a 6-valent vaccine from bacterial lysates, a non-recurrent course to the end of the study was observed in 19 patients (87 %). In the group receiving Uro-Vaxom bacterial monolysates, 20 children (72 %) had non-recurrent course (odds ratio (OR) = 2.5; P > 0.05; the minimum expected effect was 4.84). Among those who did not receive urinary antiseptic at bedtime and bacterial lysates, the non-recurrent course was reported in 13 children (40 %) (P ≤ 0.05, OR = 0.26 with a 6-valent vaccine group). A 15% improvement in the effectiveness was obtained due to elimination of Pseudomonas aeruginosa and Enterococcus faecalis when using a 6-valent bacterial lysate. Subsequently, from 24 to 30 months of follow-up, 3 more children in the Uro-Vaxom group had a relapse (P ≤ 0.05 with the Urivac group). Conclusions. Bacterial lysates significantly increase the effectiveness of therapy for recurrent urinary tract infections in children. The best results in the formation of a non-recurrent course of relapsing UTI were obtained when using a prophylactic dose of urinary antiseptic once at bedtime and a 6-valent Urivac vaccine.

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How to Cite
Ivanov, D., T. Ivanova, O. Fedorenko, S. Kushnirenko, and M. Ivanova. “Options of Modern Anti-Relapse Therapy for Urinary Tract Infections in Children: CRUTIL Trial”. KIDNEYS, vol. 8, no. 2, May 2019, pp. 80-87, doi:10.22141/2307-1257.8.2.2019.166663.
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