Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children: The authors reply

We agree with Kallen that urinary tract malformation, not urinary tract infection, may lead to kidney disease. We are interested in the attempt to reframe our objectives. More than 10 years ago, our primary aim and our design were to determine whether symptomatic urinary tract infection is prevented with prophylactic antibiotics. This goal remains as clinically important now as in 1998. We are surprised at the implication that the prevention of symptomatic urinary tract infection is not a worthwhile outcome from the perspective of the child and family. In our experience, families want to prevent further urinary tract infections. A reference to one anonymous review article provides insufficient evidence that trimethoprim–sulfamethoxazole should not be used for this indication, particularly since no adequately conducted trials providing valid estimates of benefits and harms have been reported. As we reported in Table 1 of our article, most children enrolled in the study were younger than 3 years of age. There is a limit to the number of post hoc subgroup analyses that should be done to satisfy every reader. The overall study result is the most robust and was remarkably consistent across the subgroups reported.