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Forum Name: Pediatric Topics
|ansvarma - Thu Feb 28, 2008 6:42 am||
Request for Expert Advice.
Sub:is there any side effect or bad effects for use of antibiotics for long time ?.
I have a 1 year 6 months old baby girl and her name is theertha.She got a urinary tract infection 2 months back . She was hospitalized for 9 days and antibiotics treatment was given to her.My doctor suggested to do a DMSA and MCU for her 4 weeks after discharge and continue a antibiotic tablet sporidex 125 twice daily untill scan. We did a DMSA and MCU after a month of discharge from hospital. DMSA gave no scar in kidneys .But MCU said a grade 1 reflux on left side. Doctor suggested to told to continue sporidex 125 daily once for 8 months untill next MCU done .
Could you please advice the dosage and medicine ( sporidex 125 daily once for 8 months )is correct and sufficient ? Also kindly tell is there any side effect or bad effects for continuing this medicine (sporidex 125) for such long time (8 months) for 1 and half year old kid.
Date of Birth : 8/28/2006 Sex : female Wt: 10Kg Age: 1 Y 6 months
thanks & regards
|Dr. Chan Lowe - Tue Mar 04, 2008 10:58 pm||
This is an excellent question that is actually still being studied to see which methods are the most effective. The goal of taking the prophylactic antibiotic is to prevent renal damage from repeated urinary tract infections. This basically asks two questions, then. 1) Do children with grade 1 reflux (mild reflux) get more infections and renal damage than those without reflux and 2) does prophylactic antibiotic therapy decrease the rate of UTI's and renal damage?
There is some newer data suggesting that the answer to both these questions is actually no. Grade 1 reflux is actually fairly mild and essentially all children will "grow out of" this problem. As the child gets older and bigger, the ureters get longer and the vesicoureteral valve tends to become better functioning, thereby decreasing the reflux. Many studies support that grade 1 reflux, in itself, does not increase the risk of renal damage.
Similarly, there are several good studies that show that antibiotic prophylaxis for grade 1 reflux does not decrease the rate of UTI's or renal damage from infection.
In children with higher grades of VUR (grades 4 and 5) prophylaxis benefit is more likely but still somewhat in question.
The issue of risk must be weighed in terms of benefit. I would recommend you discuss this with her doctor. The risks of long term prophylactic antibiotics is basically that there is a small risk of developing resistant bacteria that can result in more significant infections. This risk must be balanced against not taking the antibiotic and potentially developing many infections that could damage the kidneys. Basically, if there is a high risk of infection, the antibiotics may be more beneficial than the risk of developing a resistant bacteria.
I cannot say that your daughter should or should not be taking prophylactic antibiotics since I cannot evaluate her and review her chart. Often, grade 1 reflux does not need prophylaxis antibiotics. You may also want to consider having your daughter evaluated by a pediatric urologist (urinary tract specialist).
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