The Indian Journal of Pediatrics
https://doi.org/10.1007/s12098-019-03166-1
SCIENTIFIC LETTER
Antibiotic Prophylaxis for VCUG: A Cross-Sectional
Observational Study
Suprita Kalra 1
&
S. K. Dey 2 & R. Shankar 2 & Madhuri Kanitkar 1
Received: 14 May 2019 / Accepted: 20 December 2019
# Dr. K C Chaudhuri Foundation 2020
To the Editor: Standard guidelines exist for doing voiding
cystourethrogram (VCUG) in children with recurrent urinary
tract infections (UTI) and children with Congenital anomalies
of kidney and urinary tract (CAKUT) [1]. There is no consensus on whether children should be routinely given antibiotics
before VCUG or not to prevent UTI. We therefore conducted
this study with the aim to determine the frequency of UTI
following voiding cystourethrography (VCUG) under strict
asepsis with no additional antibiotic prophylaxis for the procedure. All children aged 0 to 12 y undergoing VCUG were
enrolled after informed consent. These children were put on
antibiotic prophylaxis (sulphamethoxozole + trimethoprim or
cephalexin) while awaiting VCUG as per the ISPN guidelines
[1]. Children undergoing early VCUG while on full dose of
antibiotics for treatment of UTI were excluded. All children
underwent sterile bladder catheterisation at Pediatric ward by
the duty residents. They were advised to report if they developed fever or dysuria or both within 7 d and urine microscopic
examination and culture was done. UTI was diagnosed using
standard definitions [2, 3]. Sixty-one children (35 boys/26
girls) underwent VCUG from January through December
2018 (12 mo). Five children were excluded as VCUG was
done while they were on full dose of antibiotics for UTI.
Forty-seven children (83.92%, 13 neonates, 24 infants and
10 between 1 and 5 y of age) were already on antibiotic prophylaxis. The age at the time of VCUG ranged from 6 d to 128
mo. VCUG showed posterior urethral valves (PUV) in 3, primary vesicoureteric reflux (VUR) in 24 (16 grade I-III and 8
grade IV-V) and neurogenic bladder in 4. The remaining had
* Suprita Kalra
kalrasuprita@gmail.com
1
Department of Pediatrics and Pediatric Nephrology, Command
Hospital (SC), AFMC, Pune, India
2
Department of Pediatric Surgery, Command Hospital (SC), AFMC,
Pune, India
normal VCUG. Only 2 (3.57%) children (none of whom were
on antibiotic prophylaxis as they had an apparently normal
ultrasound KUB) developed fever and /dysuria after VCUG.
Both had E. coli >105 CFU on urine culture and grade IV
VUR.
Our study elegantly brings out that risk of culture positive
UTI post VCUG when bladder catherization is done under
strict asepsis is minimal in children already on prophylactic
antibiotics and therefore additional antibiotics before VCUG
can be avoided. Larger prospective studies would be however
required to prove this conclusively.
Compliance with Ethical Standards
Conflict of Interest None.
References
1.
2.
3.
Sinha A, Bagga A, Krishna A, et al; For the Indian Society of
Pediatric Nephrology. Revised guidelines on management of antenatal hydronephrosis. Indian Pediatr. 2013;50:215–31.
Vijayakumar M, Kanitkar M, Nammalwar BR, et al. Revised statement on management of urinary tract infections. Indian Pediatr.
2011;48:709–17.
NICE guideline-Urinary tract infection in under 16s: diagnosis and
management. Available at: www.nice.org.uk/guidance/cg54/chapter/
1-Guidance#imaging-tests. Accessed 01 Feb 2018.
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