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.

Do not give routine prophylactic antibiotics to a child after the first urinary tract infection if at low risk of recurrent urinary tract infections

Date reviewed: 7 May 2021

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 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.