Nitrofurantoin, cranberry products ‘ideal’ for reducing recurrent UTIs in children
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Key takeaways:
- Nitrofurantoin decreased episodes by 79%, and cranberry juice and tablets reduced episodes by 59% compared with control groups.
- No treatment had statistically significant effects on kidney scarring.
Nitrofurantoin and cranberry products may reduce recurrent UTI episodes in children when used as prophylaxis, according to the results of a systematic review and meta-analysis published in Pediatrics.
“We noticed that clinical practice is not always based on randomized controlled trials and meta-analyses but sometimes on small observational studies and even clinical experience,” Nikolaos Gkiourtzis, MD, MSc, a pediatric specialist at Papageorgiou General Hospital School of Medicine and Aristotle University of Thessaloniki in Greece, told Healio. “Differences in everyday practice around the world come after long periods of experience and results that are not always depicted in large, published studies.”
Gkiourtzis and colleagues conducted a systematic review of 26 studies and network meta-analysis with 23 studies on recurrent UTI prophylaxis that included 3,335 pediatric participants (mean age range, 3.8-14.7 years).
More than half of the studies (n = 14) were considered to have a high risk for bias, and 9 others raised concerns for lacking well-described methodology, the researchers wrote.
Two interventions appeared to be effective for reducing recurrent UTI symptoms during prophylaxis, Gkiourtzis and colleagues learned. Cranberry juice and tablets decreased episodes by 59% compared with the control groups (OR = 0.41; 95% CI, 0.23-0.74), and nitrofurantoin reduced symptoms by 79% (OR = 0.21; 95% CI, 0.07-0.65). Nitrofurantoin was more effective than trimethoprim/sulfamethoxazole (OR = 0.29; 95% CI, 0.1-0.82) or trimethoprim alone (OR = 0.23; 95% CI, 0.08-0.66).
The researchers also evaluated secondary outcomes like UTI incidence after prophylaxis, kidney scarring and febrile UTI incidence, but no treatments had statistically significant effects.
“Current evidence does not support any prophylaxis option for kidney scar formation, but nitrofurantoin and cranberry products are ideal for UTI reduction in children with a history of recurrent UTI,” Gkiourtzis said.
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