Part 2: Examining pediatric vesicoureteral reflux: a real-world evaluation of treatment patterns and outcomes.

ABSTRACT

OBJECTIVE: Vesicoureteral reflux (VUR) occurs in 1% of infants and children. Upon diagnosis, patients are often placed on prophylactic antibiotics to prevent urinary tract infections (UTIs) and potential renal damage. The objective of this study was to assess current diagnosis and treatment patterns for patients diagnosed with VUR, focusing on compliance with antibiotic therapy and the occurrence of UTIs. METHODS: This is a retrospective study of children less than 11 years of age diagnosed with VUR. Data were obtained from a national managed care database with over 45 million lives. Patients were followed for up to 6 months prior to their diagnosis and 1 year after. All were required to be eligible for medical and pharmacy services for 1 year after diagnosis. Outcome measures included the use of and compliance with prophylactic antibiotics, rates of curative treatment (surgery and endoscopic injections), and diagnoses of UTIs. RESULTS: There were 35 450 patients meeting inclusion criteria. After being diagnosed with VUR, 76.5% of patients were placed on prophylactic antibiotics, 1.5% had open surgery, and 0.38% had an endoscopic injection with dextranomer/hyaluronic acid copolymer (Dx/HA). Only 17% of patients on prophylactic antibiotics were adherent to therapy, with mean patient compliance equaling 41.4%. Of patients on prophylactic antibiotic therapy, 58% still had a diagnosis for a UTI within 12 months of VUR diagnosis. LIMITATIONS: Adherence to VUR-related antibiotic therapy may be overestimated as the data used in the analysis represents prescriptions acquired but not necessarily consumed. This study lacked detailed clinical information, such as VUR-resolution rates and VUR grade. CONCLUSIONS: Only 17% of pediatric VUR patients on prophylactic antibiotics were compliant with therapy. Of patients on prophylactic therapy, 58% had a diagnosis of a UTI within 1 year of treatment.