Options of modern anti-relapse therapy for urinary tract infections in children: CRUTIL trial
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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DynaMed Plus. Record No. T115591, Urinary tract infection (UTI) in children. Available from: https://www.dynamed.com/topics/dmp~AN~T115591. Accessed: November 30, 2018.
Radmayr C, Bogaert G, Dogan HS, et al. EAU Guidelines: Paediatric Urology. Available from: https://uroweb.org/guideline/paediatric-urology/.
Chang SJ, Tsai LP, Hsu CK, Yang SS. Elevated postvoid residual urine volume predicting recurrence of urinary tract infections in toilet-trained children. Pediatr Nephrol. 2015 Jul;30(7):1131-7. doi: 10.1007/s00467-014-3009-y.
Craig JC, Williams GJ, Jones M, et al. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ. 2010 Apr 20;340:c1594. doi: 10.1136/bmj.c1594.
Karavanaki KA, Soldatou A, Koufadaki AM, Tsentidis C, Haliotis FA, Stefanidis CJ. Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring. Acta Paediatr. 2017 Jan;106(1):149-154. doi: 10.1111/apa.13636.
Ivanov DD, Korg OM. Nefrologija u praktyci simejnogo likarja [Nephrology in the practice of a family doctor]. Donetsk: Publisher Zaslavsky OYu; 2014. 520 p. (in Ukrainian).
Afshar K, Stothers L, Scott H, MacNeily AE. Cranberry juice for the prevention of pediatric urinary tract infection: a randomized controlled trial. J Urol. 2012 Oct;188(4 Suppl):1584-7. doi: 10.1016/j.juro.2012.02.031.
World Health Organization. Informed Consent Form Templates. Available from: https://www.who.int/rpc/research_ethics/informed_consent/en/.
Spencer JD, Bates CM, Mahan JD, et al. The accuracy and health risks of a voiding cystourethrogram after a febrile urinary tract infection. J Pediatr Urol. 2012 Feb;8(1):72-6. doi: 10.1016/j.jpurol.2010.10.012.
Tosif S, Baker A, Oakley E, Donath S, Babl FE. Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: an observational cohort study. J Paediatr Child Health. 2012 Aug;48(8):659-64. doi: 10.1111/j.1440-1754.2012.02449.x.
Pennesi M, Travan L, Peratoner L, et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 2008 Jun;121(6):e1489-94. doi: 10.1542/peds.2007-2652.
Tratselas A, Iosifidis E, Ioannidou M, et al. Outcome of urinary tract infections caused by extended spectrum beta-lactamase-producing Enterobacteriaceae in children. Pediatr Infect Dis J. 2011 Aug;30(8):707-10. doi: 10.1097/INF.0b013e31820d7ec4.
Wang HH, Gbadegesin RA, Foreman JW, et al. Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: systematic review and meta-analysis. J Urol. 2015 Mar;193(3):963-9. doi: 10.1016/j.juro.2014.08.112.
Shaikh N, Mattoo TK, Keren R, et al. Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring. JAMA Pediatr. 2016 Sep 1;170(9):848-54. doi: 10.1001/jamapediatrics.2016.1181.
Schwenger EM, Tejani AM, Loewen PS. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst Rev. 2015 Dec 23;(12):CD008772. doi: 10.1002/14651858.CD008772.pub2.
Salo J, Uhari M, Helminen M, et al. Cranberry juice for the prevention of recurrences of urinary tract infections in children: a randomized placebo-controlled trial. Clin Infect Dis. 2012 Feb 1;54(3):340-6. doi: 10.1093/cid/cir801.
Salomonsson P, von Linstow ML, Knudsen JD, et al. Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender? Infect Dis (Lond). 2016 Oct;48(10):721-5. doi: 10.3109/23744235.2016.1168937.
Ramos NL, Dzung DT, Stopsack K, et al. Characterisation of uropathogenic Escherichia coli from children with urinary tract infection in different countries. Eur J Clin Microbiol Infect Dis. 2011 Dec;30(12):1587-93. doi: 10.1007/s10096-011-1264-4.
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