Subject: Re: Antibiotics only treatment for reflux?
Forum: The Urology Forum

Topic Area: Pediatric Urology

My 2 month old daughter was diagnosed with Kidney reflux recently. She has grade 3 reflux in her right kidney and Grade 2 (borderline 3) in her left kidney. The current plan - she is on Keflex (125mg a day) for 6 months, urinalysis once a month initially, and at six months will get a repeat VCUG to see if the reflux is still occuring. If so, I gather we will repeat this six month routine until at some point they determine that it needs corrective surgery unless it corrects itself. I don't like the idea of her possibly being on antiobiotics for years - is this the only treatment option available? Is it possible to monitor her through more frequent urinalysis - say once a week? What are the effects of long term antiobiotic use? ANY info, advice, suggestions would be greatly appreciated.

Dear Lisa,
The usual routine for treatment of newly diagnosed urinary reflux is long term prophylactic antibiotics.
There is a good chance that a grade 2 or 3 reflux would resolve over time without any need for corrective surgery. The patient, however, needs to be on antibiotics to prevent infection, since this( infection) could cause renal scarring, which in turn contributes to deterioration of renal function. Frequent urinalysis is not an optimal and safe way of detection of infection, which if missed for even a few days, could cause long term problems. As the child grows and follow-up evaluation reveals the resolution of reflux, it is possible to stop the antibiotics and hope that no more infections would result. If the patient develops breakthrough urinary infection while on antibiotics, or after antibiotics were discontinued, surgical repair may have to be considered. The option of restarting a different antibiotic is also a possibility.
As far as the long term effects of antibiotics, it is possible to develop: 1) resistant bacteria, 2) sesitivity and allergy to the antibiotic or3)have side effects from the antibiotic. These can be taken care of by switching to a different antibiotic. Otherwise, there should be no major concerns for taking long term antibiotics.
The alternative to prophylactic antibiotics would be corrective surgery, which has its own indications and set of risks.
It is the more conservative and prudent route to consider antibiotics as the starting course of action.

This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568).

Sincerely;
HFHS-M.D. BE
* Keyword: vesicoureteral reflux

As a sufferer of Vesico-Ureteral Reflux, I've been on alot of antibotics. I am 25 year old female. For 5 years now, I get pyelophritis, usually once a month. I have taken Macrodantin for 3 years straight - now, I'm resistant. I'm allergic to Cipro, and Sulfa drugs. Keflex, I just finished a 10 day treatment, and I still have the infection. I am now on IV at home, with Gentamicin. I am praying this works, as I don't know where or what I am gonna do if this doesn't work.

I have reflux due to a complication in the surgery to remove Endometrisois. My right ureter was cauterized, and had to be re-implanted into the bladder. I've been told that reflux corrects itself - but its beeen 5 years. How much more infections do I have to go through before it starts to correct itself? And how does that valve grow back??

Thank you for your time! ;-)

I was born with bi-lateral-duplex-kidneys, I had an extra set of ureters which were distended and removed when I was 6 weeks old, I wasn't expected to survive but I am 30yrs old now! :) At 6yrs old I had my left uretal stump re-implanted into my bladder to correct refluxing, plus as I got older I was told I would outgrow the problems I was having.This has happened. I also underwent I.V.P's and Miturating Cystograms.
From 0 to 18yrs I was on various antibiotics constantly to start with, to prevent infections. Septrin was the main one used which I finally became resistent to, and I now take Amoxycillin or antibiotics from that family if I get an infection.
I would like to know if possible why I am experiencing a stinging, burning sensation in my urethra???, which can come and go without warning, causing great distress. It started approx one month after a bad cystitis infection (very bloody infection, first one I had got in 5yrs)July 98. I have tried anti-spasmodic tablets, as the Nephrology Unit thought I had bladder spasms, unfortunately these did not solve it, but caused inability to pass water. I have had my drink input and urine output measured on a daily basis for 2 weeks and this has shown no refluxing. My urine tested countless times and there has been no sign of infection. Bloodtests have shown very good kidney filtration. I am currently waiting for a bladder ultrasound to be carried out. Please if anyone can give advice on this problem, or has any idea what is causing it, I would like to hear.

Thank you for your time :)

J - How often do you get the infections??? I'm with ya in your fustration, trust me. I completely understand. Have they done any Renal Scans for kidney function? Reflux seems very hard to diagnose - as I went through many VCU (voiding cystourogramy's ) to find out if reflux was present. And that test isn't fun - espeically for us women. Urinating standing up, just somehow isn't natural and sometimes impossible (escpecially when you have many residents and doctors in the room with you, watching you .. ;-)

I've been very confused about Reflux being able to correct itself - especially in my circumstance where a section of my ureter was cauterized from the surgery to remove a seperate problem (Endometerosis). Now my bladder is on its side - tilted as the ureter wasn't long enough to reach. As about 1.5 to 1 inches was of necrosis (dead tissue, from being burned). You said you have your ureter re-implanted as well, but still have recurrent infections - Are you just getting cystitis (bladder infections) or pyelophritis (kidney infections)?

There has been many times when I have experinced moderate to severe pain on my right flank - after CNS (Urine culture and sensitvity) they have tested either many organisims, suggesting contaimination. Or have showed no blood, no luekecytes, and all is normal. But I've felt the pain, and had nausea. I have on the other hand had a grand total of 50 kidney infections in 5 years, that have showed actual infection in all tests. Out of the 3 VCU's tests I've had - only one came back as I have Moderate Ureteral Reflux. Its all very confusing to me, as if I have reflux - then why doesn't it show on all tests? I'm told that to correct reflux - they try the anitboics continuously as prophaylactics to prevent infections. I was on Macrodantin 100mg once a day - for 3 years, and I still got the infections. The other way to correct reflux is to re-implant the ureter. But, thats what made me have the reflux in the first place, so re-implanting it would serve little purpose I think.

So, I'm trying to educate myself in things I can do to prevent the infections, and learning all I can about the urinary tract. You can email me at chrismo@home.com. The only kind of medical background I have is I am an Instructor for CPR and First aid, but I can try to help as much as I can.

Christine

Christine e-mail sent tonight to you. Thanks for the feedback. :)

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