Urinary Tract

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Thomas M Kessler - One of the best experts on this subject based on the ideXlab platform.

Grahame H H Smith - One of the best experts on this subject based on the ideXlab platform.

  • antibiotic prophylaxis and recurrent Urinary Tract infection in children
    The New England Journal of Medicine, 2009
    Co-Authors: Jonathan C. Craig, Judy M Simpson, Alison Lowe, Graham Reynolds, Steven Mctaggart, Noel Cranswick, Jonathan R Carapetis, Gabrielle Williams, Elisabeth M Hodson, Grahame H H Smith
    Abstract:

    BACKGROUND: Antibiotics are widely administered to children with the intention of preventing Urinary Tract infection, but adequately powered, placebo-controlled trials regarding efficacy are lacking. This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy prevents Urinary Tract infection in predisposed children. METHODS: We randomly assigned children under the age of 18 years who had had one or more microbiologically proven Urinary Tract infections to receive either daily trimethoprim-sulfamethoxazole suspension (as 2 mg of trimethoprim plus 10 mg of sulfamethoxazole per kilogram of body weight) or placebo for 12 months. The primary outcome was microbiologically confirmed symptomatic Urinary Tract infection. Intention-to-treat analyses were performed with the use of time-to-event data. RESULTS: From December 1998 to March 2007, a total of 576 children (of 780 planned) underwent randomization. The median age at entry was 14 months; 64% of the patients were girls, 42% had known vesicoureteral reflux (at least grade III in 53% of these patients), and 71% were enrolled after the first diagnosis of Urinary Tract infection. During the study, Urinary Tract infection developed in 36 of 288 patients (13%) in the group receiving trimethoprim-sulfamethoxazole (antibiotic group) and in 55 of 288 patients (19%) in the placebo group (hazard ratio in the antibiotic group, 0.61; 95% confidence interval, 0.40 to 0.93; P = 0.02 by the log-rank test). In the antibiotic group, the reduction in the absolute risk of Urinary Tract infection (6 percentage points) appeared to be consistent across all subgroups of patients (P > or = 0.20 for all interactions). CONCLUSIONS: Long-term, low-dose trimethoprim-sulfamethoxazole was associated with a decreased number of Urinary Tract infections in predisposed children. The treatment effect appeared to be consistent but modest across subgroups. (Australian New Zealand Clinical Trials Registry number, ACTRN12608000470392.)

  • antibiotic prophylaxis and recurrent Urinary Tract infection in children
    The New England Journal of Medicine, 2009
    Co-Authors: Jonathan C. Craig, Judy M Simpson, Alison Lowe, Graham Reynolds, Steven Mctaggart, Noel Cranswick, Jonathan R Carapetis, Gabrielle Williams, Elisabeth M Hodson, Grahame H H Smith
    Abstract:

    Background Antibiotics are widely administered to children with the intention of preventing Urinary Tract infection, but adequately powered, placebo-controlled trials regarding efficacy are lacking. This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy prevents Urinary Tract infection in predisposed children. Methods We randomly assigned children under the age of 18 years who had had one or more microbiologically proven Urinary Tract infections to receive either daily trimethoprim–sulfamethoxazole suspension (as 2 mg of trimethoprim plus 10 mg of sulfamethoxazole per kilogram of body weight) or placebo for 12 months. The primary outcome was microbiologically confirmed symptomatic Urinary Tract infection. Intention-to-treat analyses were performed with the use of time-to-event data. Results From December 1998 to March 2007, a total of 576 children (of 780 planned) underwent randomization. The median age at entry was 14 months; 64% of the patients were girls, ...

Jure Tornic - One of the best experts on this subject based on the ideXlab platform.

Mark David Kilby - One of the best experts on this subject based on the ideXlab platform.

  • fetal lower Urinary Tract obstruction
    Seminars in Fetal & Neonatal Medicine, 2007
    Co-Authors: David Lissauer, R K Morris, Mark David Kilby
    Abstract:

    Summary Fetal lower Urinary Tract obstruction affects 2.2 per 10 000 births. It is a consequence of a range of pathological processes, most commonly posterior urethral valves (64%) or urethral atresia (39%). It is a condition of high mortality and morbidity associated with progressive renal dysfunction and oligohydramnios, and hence fetal pulmonary hypoplasia. Accurate detection is possible via ultrasound, but the underlying pathology is often unknown. In future, magnetic resonance imaging (MRI) may be increasingly used alongside ultrasound in the diagnosis and assessment of fetuses with lower Urinary Tract obstruction. Fetal urine analysis may provide improvements in prenatal determination of renal prognosis, but the optimum criteria to be used remain unclear. It is now possible to decompress the obstruction in utero via percutaneous vesico-amniotic shunting or cystoscopic techniques. In appropriately selected fetuses intervention may improve perinatal survival, but long-term renal morbidity amongst survivors remains problematic.

Jonathan C. Craig - One of the best experts on this subject based on the ideXlab platform.

  • antibiotic prophylaxis and recurrent Urinary Tract infection in children
    The New England Journal of Medicine, 2009
    Co-Authors: Jonathan C. Craig, Judy M Simpson, Alison Lowe, Graham Reynolds, Steven Mctaggart, Noel Cranswick, Jonathan R Carapetis, Gabrielle Williams, Elisabeth M Hodson, Grahame H H Smith
    Abstract:

    BACKGROUND: Antibiotics are widely administered to children with the intention of preventing Urinary Tract infection, but adequately powered, placebo-controlled trials regarding efficacy are lacking. This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy prevents Urinary Tract infection in predisposed children. METHODS: We randomly assigned children under the age of 18 years who had had one or more microbiologically proven Urinary Tract infections to receive either daily trimethoprim-sulfamethoxazole suspension (as 2 mg of trimethoprim plus 10 mg of sulfamethoxazole per kilogram of body weight) or placebo for 12 months. The primary outcome was microbiologically confirmed symptomatic Urinary Tract infection. Intention-to-treat analyses were performed with the use of time-to-event data. RESULTS: From December 1998 to March 2007, a total of 576 children (of 780 planned) underwent randomization. The median age at entry was 14 months; 64% of the patients were girls, 42% had known vesicoureteral reflux (at least grade III in 53% of these patients), and 71% were enrolled after the first diagnosis of Urinary Tract infection. During the study, Urinary Tract infection developed in 36 of 288 patients (13%) in the group receiving trimethoprim-sulfamethoxazole (antibiotic group) and in 55 of 288 patients (19%) in the placebo group (hazard ratio in the antibiotic group, 0.61; 95% confidence interval, 0.40 to 0.93; P = 0.02 by the log-rank test). In the antibiotic group, the reduction in the absolute risk of Urinary Tract infection (6 percentage points) appeared to be consistent across all subgroups of patients (P > or = 0.20 for all interactions). CONCLUSIONS: Long-term, low-dose trimethoprim-sulfamethoxazole was associated with a decreased number of Urinary Tract infections in predisposed children. The treatment effect appeared to be consistent but modest across subgroups. (Australian New Zealand Clinical Trials Registry number, ACTRN12608000470392.)

  • antibiotic prophylaxis and recurrent Urinary Tract infection in children
    The New England Journal of Medicine, 2009
    Co-Authors: Jonathan C. Craig, Judy M Simpson, Alison Lowe, Graham Reynolds, Steven Mctaggart, Noel Cranswick, Jonathan R Carapetis, Gabrielle Williams, Elisabeth M Hodson, Grahame H H Smith
    Abstract:

    Background Antibiotics are widely administered to children with the intention of preventing Urinary Tract infection, but adequately powered, placebo-controlled trials regarding efficacy are lacking. This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy prevents Urinary Tract infection in predisposed children. Methods We randomly assigned children under the age of 18 years who had had one or more microbiologically proven Urinary Tract infections to receive either daily trimethoprim–sulfamethoxazole suspension (as 2 mg of trimethoprim plus 10 mg of sulfamethoxazole per kilogram of body weight) or placebo for 12 months. The primary outcome was microbiologically confirmed symptomatic Urinary Tract infection. Intention-to-treat analyses were performed with the use of time-to-event data. Results From December 1998 to March 2007, a total of 576 children (of 780 planned) underwent randomization. The median age at entry was 14 months; 64% of the patients were girls, ...

  • cranberries for treating Urinary Tract infections
    Cochrane Database of Systematic Reviews, 1998
    Co-Authors: Ruth Jepson, Lara Mihaljevic, Jonathan C. Craig
    Abstract:

    BACKGROUND Cranberries (particularly in the form of cranberry juice) have been used widely for several decades for the prevention and treatment of Urinary Tract infections. The aim of this review is to assess the effectiveness of cranberries in treating such infections. OBJECTIVES To assess the effectiveness of cranberries for the treatment of Urinary Tract infections. SEARCH STRATEGY The search strategy developed by the Cochrane Renal Group was used. Also, companies involved with the promotion and distribution of cranberry preparations were contacted; electronic databases and the Internet were searched using English and non English language terms; reference lists of review articles and relevant trials were also searched. SELECTION CRITERIA All randomised or quasi randomised controlled trials of cranberry juice or cranberry products for the treatment of Urinary Tract infections. Trials of men, women or children were included. DATA COLLECTION AND ANALYSIS Titles and absTracts of studies that were potentially relevant to the review were screened by one reviewer, RJ, who discarded studies that were clearly ineligible but aimed to be overly inclusive rather than risk losing relevant studies. Reviewers RJ and LM independently assessed whether the studies met the inclusion criteria. Further information was sought from the authors where papers contained insufficient information to make a decision about eligibility. MAIN RESULTS No trials were found which fulfilled all of the inclusion criteria. Two trials were excluded because they did not have any relevant outcomes. REVIEWER'S CONCLUSIONS After a thorough search, no randomised trials which assessed the effectiveness of cranberry juice for the treatment of Urinary Tract infections were found. Therefore, at the present time, there is no good quality evidence to suggest that it is effective for the treatment of Urinary Tract infections. Well-designed parallel group, double blind trials comparing cranberry juice and other cranberry products versus placebo to assess the effectiveness of cranberry juice in treating Urinary Tract infections are needed. Outcomes should include reduction in symptoms, sterilisation of the urine, side effects and adherence to therapy. Dosage (amount and concentration) and duration of therapy should also be assessed. Consumers and clinicians will welcome the evidence from these trials.

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