Antibiotic prophylaxis in the context of VCUG/VUS in children: results of a multinational survey

Voiding cystourethrography (VCUG) and voiding urosonography (VUS) are standard procedures in children for diagnosing vesicoureteral reflux (VUR) but may cause postprocedural urinary tract infections (ppUTIs). The necessity of periprocedural antibiotic prophylaxis remains controversial, and no standardized guidelines exist. This survey investigates current antibiotic prophylaxis practices among paediatric specialists performing VCUG/VUS. An online questionnaire was distributed to paediatricians, paediatric radiologists, paediatric nephrologists, paediatric surgeons, and paediatric urologists to evaluate current practices regarding antibiotic prophylaxis in the context of VCUG and VUS. A total of 126 responses from 20 countries were analyzed, mostly from Germany (63%, 79/126). Antibiotic prophylaxis during VCUG/VUS was routinely used by 58% (73/126) of respondents, while 13% (16/126) reported never using it and 29% (37/126) refrained from antibiotic prophylaxis in specific circumstances. Trimethoprim, cefaclor, and nitrofurantoin were the most common agents, with 48% (53/110) of respondents adapting their choice of antibiotic according to the patient’s age. Dosage and timing varied widely, including prophylactic, therapeutic, and double prophylactic doses. Age-inappropriate drug use was reported in 15% (16/110) of respondents. Significant differences between specialties were not found, but marked international variation in prophylaxis practices was observed. This survey demonstrates substantial variability in periinterventional antibiotic prophylaxis for VCUG and VUS in children. Differences in indication, agent choice, dosing, and time schedule reflect the absence of unified evidence-based standards. A standardized, multidisciplinary approach integrating current evidence and individual risk assessment is essential to optimize patient safety and antimicrobial stewardship.