PROSPECTIVE BLINDED LABORATORY ASSESSMENT OF PROPHYLACTIC ANTIBIOTIC COMPLIANCE

You have accessJournal of UrologyPediatrics: Imaging (Genital & Urinary Tract)/Infections and Vesicoureteral Reflux1 Apr 2012625 PROSPECTIVE BLINDED LABORATORY ASSESSMENT OF PROPHYLACTIC ANTIBIOTIC COMPLIANCE Jenny Yiee, Laurence Baskin, Neal Patel, Jennifer Yang, and Michael Disandro Jenny YieeJenny Yiee Los Angeles, CA More articles by this author , Laurence BaskinLaurence Baskin San Francisco, CA More articles by this author , Neal PatelNeal Patel San Francisco, CA More articles by this author , Jennifer YangJennifer Yang Davis, CA More articles by this author , and Michael DisandroMichael Disandro San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.703AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Providers commonly use prophylactic antibiotics to prevent urinary tract infections in children with conditions such as vesicoureteral reflux. The efficacy of prophylaxis is still unclear. Patient compliance with antibiotics is salient given the effects non-compliance might have on outcomes of clinical trials and the development of antibiotic resistance. Prior studies have shown variable compliance (17-70%) with no study using objective methods of assessment. We hypothesize that direct measurement of urine antibiotic levels will demonstrate poor compliance. METHODS Eligibility included children aged 0-18 years. All children taking trimethoprim prophylaxis for any urologic diagnosis were approached for recruitment during a pediatric urology clinic visit. All subjects were unaware of any potential urine testing prior to the visit. Urine samples were sent for chromatography to quantify the amount of trimethoprim present. Subjects' parents also completed a self-assessment of compliance. RESULTS Of those approached, 97% consented to participate (total n=54). 91% were compliant based on urine levels of trimethoprim. Factors not associated with compliance were age; sex; self-report of compliance; duration of time on antibiotics; insurance status; and history of surgery, pyelonephritis, hospitalization, or breakthrough infection. CONCLUSIONS We demonstrate the highest compliance reported. We attribute this unexpected result to a specialist's discussion of one problem for the duration of an entire visit. All teaching in this study occurred as part of clinic care, thus our results should be generalizable to a non-study environment. Future studies should confirm if this high compliance can be achieved with nephrologists and general pediatricians. If such high compliance cannot be achieved in non-surgical clinics, then early referral to pediatric urologists may be warranted. Table 1. Analysis of factors associated with compliance. Total N=54 Median age in years(IQR) 2.9(.9-5.3) Median months taking prophylactic antibiotics (IQR) 9(3-24) Median mcg/ml of trimethoprim in urine(IQR) 6.8(1.5-20) N(%) Male 31(57) Compliant with prophylactic antibiotics (urine level > 0.5 mcg/ml) 49(91) Vesicoureteral refluxa 37(68.5) History of UTI 31(57.4) History of pyelonephritis 25(46.3) History of hospitalization 30(55.6) History of breakthrough UTI 8(14.8) History of genitourinary surgeryb 25(46.3) Insurance type Private 39(72.2) Indigentc 15(27.8) Self reported doses missed per month None 33(61) 1-2 11(20) 3-5 6(11) Stopped 2(4) Not answered 2(4) Reasons for missing doses Forgetfulness 10(71) Child dislikes taste 3(21) Need prescription filled 1(7) a The diagnosis of vesicoureteral reflux may occur alone or in conjunction with other diagnoses such as duplex kidneys or myelomeninogocele, among others. b Surgeries include: first and second stage hypospadias repair, ureteral reimplant, orchiopexy, urachal remnant removal, deflux injection, repair of cloaca, cutaneous ureterostomy, repair of bladder of bladder exstrophy, laparoscopic nephrectomy, pyeloplasty, and ureterocele puncture. c Indigent defined as California Childrens' Service (CCS), Medi-cal, Medicaid, County of San Francisco Medically Indigent, or other County based insurance. Table 2. Analysis of factors associated with compliance. Non-compliant, N(%) Compliant, N(%) P value Median age in years 0.8 3 0.2a Median months taking prophylactic antibiotics 9.5 9 0.4a Sex Female 2(40) 21(43) 1.0b Male 3(60) 28(57) Vesicoureteral Reflux No 1(20) 16(33) 1.0b Yes 4(80) 33(67) Insurance Private 3(60) 36(73) 0.6b Indigent 2(40) 13(27) Any history of UTI, pyelonphritis, or hospitalization No 1(20) 11(22) 1.0b Yes 4(80) 38(78) History of breakthrough UTI No 4(80) 42(86) 0.6b Yes 1(20) 7(14) History of genitourinary surgery No 5(100) 24(49) 0.054b Yes 0 25(51) Self report of compliancec No 2(40) 6(13) 0.1b Yes 3(60) 41(87) a Mann-Whitney U test. b Fisher's exact. c Self report of compliance was dichotomized to “yes” if the subject answered missing 0-2 doses per month and “no” if missing 3 or greater doses per month. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e254-e255 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jenny Yiee Los Angeles, CA More articles by this author Laurence Baskin San Francisco, CA More articles by this author Neal Patel San Francisco, CA More articles by this author Jennifer Yang Davis, CA More articles by this author Michael Disandro San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...