Daily vs. Every-Other-Day Antibiotic Prophylaxis in Children with Vesicoureteral Reflux: A Randomized Clinical Trial

Background: Vesicoureteral reflux (VUR) is a relatively common, predominantly hereditary urinary tract disorder in children. If not properly diagnosed and treated, it can lead to irreversible complications. Prophylactic management typically involves administering oral antibiotics at doses lower than therapeutic levels; however, prolonged use in children is associated with potential adverse effects. Objectives: This study aimed to compare the effectiveness of prophylactic antibiotics administered every other day versus daily in children with VUR. Methods: In this two-group clinical trial, 40 children with primary VUR who visited the Hajar Educational and Therapeutic Center and nephrology clinics affiliated with Shahrekord University of Medical Sciences in 2023 were randomly assigned into two groups — one receiving antibiotic prophylaxis every other day and the other receiving it daily. One group received cephalexin at a dose of 15 mg/kg orally every other night, while the other group received it daily for 12 months. Before the initiation of each treatment period, kidney and urinary tract ultrasounds, as well as urine cultures, were performed. Participants in each study group were assessed for fever, pyuria, urinary frequency, urine culture, and ultrasonographic findings. After 12 months, the clinical and laboratory results of the two groups were compared and statistically analyzed. Data were recorded using a checklist and analyzed using SPSS version 22 with descriptive and analytical statistical tests. Results: The results indicated no statistically significant differences in mean age or gender distribution between the daily and every-other-night antibiotic groups (P ≥ 0.05). Fisher’s exact test showed no significant differences between the groups in urinary frequency, pyuria, and urine culture results (P > 0.8), fever (P > 0.23), or ultrasound findings (P ≥ 0.47). Conclusions: Prophylactic antibiotics administered either daily or every other night show no significant difference in reducing urinary tract infections (UTIs) or improving clinical outcomes in children with VUR. Therefore, potential antibiotic resistance and the side effects associated with long-term use should be key considerations when selecting prophylactic strategies for patients with VUR.