Is antibiotic prophylaxis necessary in children with mild to moderate vesicoureteral reflux, II-III grade?

Author’s conclusions: the systematic review concludes that there is not enough evidence to recommend or not the use of antibiotic prophylaxis in children with vesicoureteral reflux. The guideline practice, with a C evidence level, does not recommend antibiotic prophylaxis for children with I-III grade vesicoureteral reflux. Finally the randomized controlled trial shows that antibiotic prophylaxis in children 1-30 months with vesicoureteral reflux grade IIV is not effective in reducing the rate of infection or the incidence of renal damage or progression.

Reviewers’ commentary: evidence shows that antibiotic prophylaxis in children 1-30 months old with vesicoureteral reflux grade I-IV is not effective in preventing urinary tract infections. Even though it is not clear the role of urinary infections in the progressive damage of renal parenchyma in children with vesicoureteral reflux, it seems acceptable that an early and correct diagnosis and prompt treatment remain the basis of the management of these children.