Regardless of the grade of reflux or presence of renal scars, all patients diagnosed within the first year of life should be treated initially with CAP. During early childhood, the kidneys are at higher risk of developing new scars. Immediate, parenteral antibiotic treatment should be initiated for febrile breakthrough infections. Definitive surgical or endoscopic correction is the preferred treatment in patients with frequent breakthrough infections.
There is no evidence that correction of persistent low-grade reflux (grades I–III) without symptoms and normal kidneys offers a significant benefit. These patients may be candidates for endoscopic treatment.
In all children presenting at age 1–5 years, CAP is the preferred option for initial therapy. For those with high-grade reflux or abnormal renal parenchyma, surgical repair is a reasonable alternative. In patients with lower grades of reflux and without symptoms, close surveillance without antibiotic prophylaxis may be an option.
A detailed investigation for the presence of LUTD should be performed in all children after toilet-training. If LUTD is found, the initial treatment should always be for LUTD.
If parents prefer definitive therapy to conservative management, surgical correction may be considered. Endoscopic treatment is an option for all children with low grades of reflux.
CAP = continuous antibiotic prophylaxis