Editing AUA: Vesicoureteral Reflux (2017) (section)

=== Antibiotic prophylaxis ===
* '''<span style="color:#ff00ff">RIVUR (NEJM 2014)'''
** '''Population: 607 children with''' dilated and non-dilated '''VUR that was diagnosed after''' a first or second '''febrile or symptomatic UTI'''
*** Majority (91%) female population
*** Half of study participants were < 11 months of age
** '''Randomized to trimethoprim-sulfamethoxazole prophylaxis vs. placebo'''
** '''Primary outcome: recurrence of UTI'''
** '''Results:'''
*** '''45% significant decrease in recurrence of UTI with antibiotic prophylaxis''' (RR: 0.55; 95% CI: 0.38-0.78)
**** When stratified into dilated and non-dilated groups, children with dilated VUR were more likely to have symptomatic recurrences than those with non-dilated VUR
**** '''Prophylaxis was particularly effective in children'''
****# '''Whose index infection was febrile'''
****# '''Those with baseline BBD'''
*** '''No difference in the occurrence of renal scarring'''
** '''Criticisms:'''
*** '''Population may not reflect typical patient in practice'''
**** '''Majority female and half under age 11 months'''
**** '''Trial does not address patients with VUR and no history of UTI'''
** [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691529/ RIVUR Trial Investigators. Antimicrobial prophylaxis for children with vesicoureteral reflux. NEJM 2014; 370: 2367.]