Subject: 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! ;-)

Dear Christine,
It appears that you have a very frustrating problem. From the history that you have given, the most likely problem is that the right side continues to have reflux .. Given the length of time since your surgery, it is unlikely that the reflux would resolve. With this history of recurrent pyelonephritis and chronic antibiotics, I think it is appropriate for you to have a repeat evaluation by a urologist for a possible repeat procedure to relieve the reflux.

As far the valve, I suspect that you are talking about the valve mechanism at the opening of the ureter to the bladder. This is not exactly a valve, but a mechanism that acts like a valve. It has to do with the ratio of the length of the ureter that is reimplanted within the bladder muscle, to the diameter of the ureter. A ratio of 5 to 1 imparts a valve like function to this reimplanted system.

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:urinary reflux

Hi,

Thanks for reponding.

I guess, my question would be that if they re-implanted it again - how would it work that relfux wouldn't be present again?

I've finished the Gentamicin after 10 days of it - and they put me back on keflex as a precaution for 14 days. But when they catherized me yesterday, my urine was clear but showed protein. Now, I'm really confused as to why that would be in there.

I must say I feel better since the gentamicin, although I do experince occasional flank pain - but the nausea is gone ( and thats the worst part for me ..) But the headaches, that I have when this "episodes" happen are sometimes unbearable. I don't know if that is any way related - but when I don't have an infection I rarely get headaches .. So, it seemed odd to me.

The next step now, is more tests - but it is a long wait to see the urologist that I was just refered to. Not until October .. ( Canada's Health care system is great :) )

Thanks again for your time !

Christine

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