Our centre has been practicing pre-procedural single dose of intramuscular(IM) gentamicin as Urinary Tract Infection(UTI) prophylaxis for Micturating Cystourethrography(MCUG).
- Primary: Quality assurance project to compare oral trimethoprim to IM gentamicin in reducing MCUG-related stress score
- Secondary: Evaluate the risk of post-procedural UTI(ppUTI) in each group, family preference of antibiotic administration and adherence to antibiotic prophylaxis.
This study conduct in two phases, each lasted 9 months. First phase patients received single dose IM gentamicin prior to MCUG except patients with eGFR< 60ml/min/1.73m2 to receive oral trimethoprim. Second phase patients received 3 days of oral trimethoprim started day before the procedure. Preferences type of antibiotic prophylaxis and stress scores of having respective antibiotic were recorded after the procedure. They were followed up with phone interview at one week and later in clinic.
56 patients were recruited. (IM gentamicin, n=17, oral trimethoprim, n=39). The median age was 9 months (4 days–14 years).
Mean stress score of IM gentamicin group was 3.9, oral trimethoprim group recorded 0. (p =0.000)
Three oral trimethoprim users (7.89%) developed ppUTI, none from IM gentamicin group. (p =0.244). All 3 were younger than 3 months.
Ninety percent of the patients preferred oral trimethoprim. The oral trimethoprim group reported a full adherence. The positive pick-up rate of urinary tract anomaly from MCUG was 34%.
Oral trimethoprim significantly alleviates the stress of the procedure with excellent family adherence and family preference. Oral trimethoprim should be choice of antibiotic prophylaxis for children > 3 months old.
2. Phillips, D., Watson, A., & MacKinlay, D. Distress and the micturating cystourethrogram: does preparation help? Acta Paediatrica 2007:87(2), 175–179. DOI: 10.1080/08035259850157624
3. Völkl-Kernstock, S., Felber, M., Schabmann, A., Inschlag, N., Karesch, L., Ponocny-Seliger, E., & Friedrich, M. H. Comparing stress levels in children aged 2–8 years and in their accompanying parents during first-time versus repeated voiding cystourethrograms. Wiener Klinische Wochenschrift 2008:120(13-14), 414–421. DOI: 10.1007/s00508-008-1001-x
4. Guignard JP. Urinary infection after micturating cystography. Lancet 1979;1:103. DOI: 10.1016/s0140-6736(79)90091-6
5. Maskell R, Pead L, Vinnicombe J. Urinary infection after micturating cystography. Lancet 1978;2:1191-2. http://dx.doi.org/10.1590/1984-0462/2021/39/2019386
6. Mc Alister WH, Cacciarelli A, Shackelford GD. Complication associated with cystourethrography in children. Radiology 1974; 111:167-72. DOI: 10.1148/111.1.167
7. Glynn B, Gordon IR. The risk of infection of urinary tract as a result of micturating cystourethrography in children. Ann Radiol (Paris) 1970; 13:283-87
8. Craig JC, Knight JF, Sureshkumar P, Lam A, Onikul E, Roy LP. Vesicoureteric reflux and timing of micturating cystourethrography after urinary tract infection. Archives of Disease in Childhood 1997;76:275-277. DOI: 10.1136/adc.76.3.275
9. Schwartz GJ and Work DF. Measurement and estimation of GFR in children and adolescent. Am Soc Nephrol. 2009; Nov; 4(11): 1832-643. DOI: 10.2215/CJN.01640309
10. Schwartz GJ, Munoz A, Schneider MF, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009; 20: 629-637. DOI: 10.1681/ASN.2008030287
11. Sinha R, Saha S, Maji B, Tse Y. Antibiotics for performing voiding cystourethrogram: a randomised control trial. Arch Dis Child. 2018 Mar;103(3):230-234. DOI: 10.1136/archdischild-2017-313266
12. Hayward RS, Harding J, Molloy R. Adverse effects of a single dose of gentamicin in adults: a systematic review. Br J Clin Pharmacol. 2018;84:223–238. DOI: 10.1111/bcp.13439
13. JKF Chan, JHK Ngan, G.Lo. Voiding Cystourethrography: How I do it. HK J Peadiatr 2008; 13: 120-124. http://www.hkjpaed.org/pdf/2008;13;120-124.pdf
14. Robinson M, Savage J, Steward M, Sweeney L. The diagnostic value, parental and patient acceptability of micturating cystourethrography in children. Ir Med J 1999; 92: 366-8. https://doi.org/10.1007/s00508-008-1001-x
15. Fried GW, Goetz G, Potts?Nulty S, Solomon G, Cioschi HM, Staas WEJ. Prospective evaluation of antibiotic prophylaxis prior to cystometrogram and/or cystogram studies: oral versus intramuscular routes. Arch Phys Med Rehabil 1996; 77: 900–902. https://www.archives-pmr.org/article/S0003-9993(96)90278-6/pdf
16. National Institute for Health and Care Excellence. Urinary Tract Infection in under 16s: diagnosis and management. (NICE guideline CG54). 2017.
17. Marzuillo P, Guarino S, Esposito T, Campana G, Stanco M, Rambaldi PF. et al. Antibiotics for urethral catheterization in children undergoing cystography: retrospective evaluation of a single center cohort of pediatric non toilet trained patients. Eur J Pediatr. 2019;178, 423-425. DOI: 10.1007/s00431-018-3288-6
18. Moorani KN, Parkash J, Lohano MK. Urinary tract infection in children undergoing diagnostic voiding cystourethrography. J Surg Pakistan 2010;15:68-72
19. Johnson EK, Malhotra NR, Shannon R, Jacobson DL, Green J, Rigsby CK et al. Urinary tract infection after voiding cystourethrogram. J Pediatr Urol. 2017 Aug;13(4):P384.E1 - 384.E7. DOI: 10.1016/j.jpurol.2017.04.018
20. Malhotra NR, Green JR, Rigsby CK, Holl JL, Cheng EY, Johnson EK. Urinary tract infection after retrograde urethrogram in children: A multicenter study. J Pediatr Urol. 2017 Dec;13(6),623.E1–623.E5. https://doi.org/10.1016/j.jpurol.2017.04.026
21. Vates TS, Shull MJ, Underberg-Davis SJ, Fleisher MH. Complications of voiding cystourethrography in the evaluation of infants with prenatally detected hydronephrosis. J Urol 1999;162:1221-3. DOI: 10.1097/00005392-199909000-00102
22. Rachmiel M, Aladjem M, Starinsky R, Strauss S, Villa Y, Goldman M. Symptomatic urinary tract infections following voiding cystourethrography. Paediatr Nephrol 2005 Oct;20(10):1449-52. DOI: 10.1007/s00467-005-1942-5
23. MS Kim, SH Lee, JH Kim, YB Chang, DY Lee. Study of Post Procedural Complications Associated with Voiding Cystourethrography. Child Kidney Dis. 2007;11 (1): 65-73. https://doi.org/10.3339/jkspn.2007.11.1.65
24. Kangin M, Aksu N, Yavascan O, Anil M, Kara OD, Bal A et al. Significance of Postnatal Follow-up of Infants with Vesicoureteral Reflux Having Antenatal Hydronephrosis. Iran J Pediatr. 2010 Dec;20(4):427-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3446090/pdf/IJPD-20-427.pdf
25. Visuri, S., Kivisaari, R., Jahnukainen, T. et al. Postnatal imaging of prenatally detected hydronephrosis—when is voiding cystourethrogram necessary? Pediatr Nephrol 2018:33, 1751–1757. https://doi.org/10.1007/s00467-018-3938-y
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