The Australian and New Zealand Society of Nephrology
The Australian and New Zealand Society of Nephrology is a not-for profit organisation representing the interests of health professionals committed to the prevention and treatment of kidney disease. Through the ANZSN, members support a range of research, education and clinical care initiatives to promote evidenced based practice and quality outcomes for patients in Australia, New Zealand and our region.
3.
Do not give routine prophylactic antibiotics to a child after the first urinary tract infection if at low risk of recurrent urinary tract infections
A conservative approach to the management of urinary tract infection (UTI) is warranted for most children. While the evidence related to risk factors for recurrent UTIs and the risks and benefits of antibiotic prophylaxis in children is limited, the existing evidence indicates that antimicrobial prophylaxis is not associated with decreased risk of recurrent UTI but is associated with an increased risk of resistant infections. Accordingly, the routine use of prophylactic antibiotics for children after a first UTI is not recommended.
Supporting evidence
Conway PH, Cnaan A, Zaoutis T et al. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA. 2007; 298: 179-86
Diagnosis and Treatment of Urinary Tract Infection in Children. Steven McTaggart, Margie Danchin, Michael Ditchfield, Ian Hewitt, Joshua Kausman, Sean Kennedy, Peter Trnka1, Gabrielle Williams. Nephrology October 2014
Larkins, N.G., Hewitt, I.K. Urinary Tract Infection in Children. Curr Pediatr Rep 6, 259–268 (2018).
How this list was made
The Australian and New Zealand Society of Nephrology (ANZSN) Clinical Policy and Advisory Committee worked with the RACP, as part of the Evolve Program, to develop a long list of low-value practices and interventions that pertain to the specialty. Through extensive research and redrafting, the list was condensed to the top-5 recommendations for reducing low-value practices in nephrology. Dr David Tunnicliffe has been the Lead Fellow on the project.
The list of recommendations was then subject to an extensive review process that involved key College societies with an interest or professional engagement with nephrology as well as health equity. It was then further consulted with other medical colleges through Choosing Wisely Australia. Feedback received in the consultations led to further research and finetuning of the list, which was then finalised and approved by the ANZSN.
- 1 Do not give multiple daily doses of aminoglycoside antibiotics to patients with normal and stable kidney function as the risk of toxicity is less with a single daily dose
- 2 Do not use oral acetylcysteine before giving radiocontrast to patients at increased risk for contrast-induced acute kidney injury
- 3 Do not give routine prophylactic antibiotics to a child after the first urinary tract infection if at low risk of recurrent urinary tract infections
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4
Do not intensively lower HbA1C<6.5% to <8.0% in patients with early (stage 1-3) chronic kidney disease as intense lowering increases the risk of hypoglycaemia and mortality, noting that the individual target depends on factors such as severity of CKD, macrovascular complications, comorbidities, life expectancy and others
- 5 Do not prescribe aspirin therapy for primary prevention of cardiovascular disease in patients with stage 1-3 chronic kidney disease as there is no proven benefit and it is associated with increased risk of impaired haemostasis