PubMed · 10086953
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J Smith, A Finn. 1999. Antimicrobial prophylaxis.. https://doi.org/10.1136/adc.80.4.388
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BACKGROUND: The recurrence rate for urinary tract infections in children is estimated at between 30% and 40%. The use of low doses of antibiotics as prophylaxis for recurrent urinary tract infections is common clinical practice. However, prolonged antimicrobial therapy has the potential to contribute to problems of bacterial resistance and antimicrobial side effects. The aim of this review was to systematically examine the available evidence for the effectiveness of this intervention. METHODS: We conducted a literature search of 3 electronic databases for the period 1966 to 1999. We also searched bibliographies from conference proceedings and contacted content experts to ensure completeness of our database. Each trial was evaluated on the basis of the following inclusion criteria: target population (children), intervention (antibiotic v. no antibiotic), outcome (number of urinary tract infections) and study design (randomized controlled trial). Quality was assessed for the studies that met these criteria. RESULTS: Most of the studies identified were case series and cohort studies. Only 6 randomized trials fulfilled the inclusion criteria. All were of low quality (median 2, range 0 to 2 [maximum quality score 5]). Three trials dealt with children who had anatomically normal urinary tracts, and three included children with neurogenic bladder. The rate of infections for patients with normal urinary tracts ranged from 0 to 4.0 per 10 patient-years for the treatment groups and from 4.0 to 16.7 for the control groups. The recurrence rates for patients with neurogenic bladders in 2 trials were 2.9 and 17.1 per 10 patient-years for the treatment groups and 1.5 and 33.0 for the control groups. INTERPRETATION: The available evidence for using antimicrobial prophylaxis to prevent urinary tract infection in children with normal urinary tracts or neurogenic bladder is of low quality. This suggests that the magnitude of any benefit should at best be questioned. The surprising lack of data for children with reflux is of concern. Well-designed trials are needed to optimize the use of antimicrobials in children with recurrent urinary tract infection.
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The principles of evidence-based medicine (EBM) are summarized. The surgical activity of the author's team is analysed to answer the question of whether the principles of EBM prevail in their surgical treatment of colorectal cancer. Results of some comparative studies are presented as concerns preoperative preparation, antibiotic prophylaxis, and the development of the suture technique applied. The changes of radicality in the surgery of colorectal cancer are discussed. It is emphasized that three newly developed procedures are routinely used in their practice to enhance surgical radicality and to improve the 5-year survival rate: 1. subtotal colectomy for obstructive left side colonic tumours, 2. total mesorectal excision for middle and lower third rectal cancer, and 3. multivisceral resections for the treatment of advanced colorectal tumours. The advantages of new methods recently introduced in Hungarian colorectal surgery are guaranteed by previous published studies. The team has made efforts to develop new methods and to control the results in routine surgery. Only the surgical practice during the past few years could be influenced by the principles of EBM, but even so the maintenance of surgical standards, the application of results of well-documented reliable studies and efforts to develop new and better methods reflect principles equivalent to those of EBM in colorectal surgery in the past two decades.