Table 12.

Summary of recommendations with strength of recommendations and quality of evidence. According to the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology.

Clinical Questions	Recommendations	Strength and Quality
Should continuous antibiotic prophylaxis be used in all children with a previous UTI?	Continuous antibiotic prophylaxis is not routinely indicated in all children after the first episode of UTI.	Strong recommendation against the intervention. Evidence quality: B
Should continuous antibiotic prophylaxis be used in all children with a history of recurrent UTIs?	A history of recurrent UTIs without underlying urological anomalies does not constitute a sufficient indication for continuous antibiotic prophylaxis.	Weak recommendation against the intervention. Evidence quality: C
	Short-term prophylaxis may be considered until the exclusion of urological anomalies.	Weak recommendation for the intervention. Expert opinion
Should continuous antibiotic prophylaxis be used in all children with VUR of any grade?	Continuous antibiotic prophylaxis is not recommended for children with low-grade (I–II) or non-dilating VUR.	Strong recommendation against the intervention. Evidence quality: B
	Close surveillance based on early diagnosis (i.e., urinalysis and urine culture) and prompt antibiotic therapy in symptomatic/febrile children may be considered in children with VUR of any grade.	Weak recommendation. Expert opinion
Should continuous antibiotic prophylaxis be used in all children with high-grade VUR (III–V)?	Considering the lack of effect of antibiotic prophylaxis on the risk of renal scarring, continuous antibiotic prophylaxis is not routinely recommended in children with high-grade (III–IV) or dilating VUR.	Weak recommendation against the intervention. Evidence quality: B
	Close surveillance based on early diagnosis (i.e., urinalysis and urine culture) and prompt antibiotic therapy in symptomatic/febrile children is recommended in children with VUR of any grade.	Weak recommendation. Expert opinion
Should antibiotic prophylaxis be used in children with isolated hydronephrosis?	Continuous antibiotic prophylaxis is not routinely recommended in children with isolated antenatal or postnatal hydronephrosis or ureteropelvic junction obstruction.	Weak recommendation against the intervention. Evidence quality: C
Should antibiotic prophylaxis be used in children with infravesical obstructions (i.e., urethral valves)?	There is no sufficient evidence to define the efficacy and safety of continuous antibiotic prophylaxis in children with infravesical obstructions. Continuous antibiotic prophylaxis may be considered until surgical correction.	Weak recommendation for the intervention. Expert opinion
Should antibiotic prophylaxis be used in children with hydroureteronephrosis (i.e., primary obstructive megaureter)?	Continuous antibiotic prophylaxis may be considered in children with hydroureteronephrosis and ureteral dilation > 7 mm or primary obstructive megaureter.	Weak recommendation for the intervention. Evidence quality: C
Should antibiotic prophylaxis be used in children with neurogenic bladder?	Continuous antibiotic prophylaxis is not routinely recommended in children affected by neurogenic bladder.	Weak recommendation against the intervention. Evidence quality: C
	Proper execution of clean intermittent catheterization and close surveillance, based on early diagnosis (i.e., urinalysis and urine culture) and prompt antibiotic therapy in symptomatic/febrile children, may be considered in children with neurogenic bladder.	Weak recommendation. Expert opinion
Which antibiotic should be preferred for long-term prophylaxis of UTI in children?	There is insufficient evidence to recommend trimethoprim–sulfamethoxazole rather than nitrofurantoin as the first-choice prophylactic antibiotic. There is no evidence on the efficacy and safety of amoxicillin–clavulanic acid as a prophylactic antibiotic to prevent UTIs. The prophylactic use of oral cephalosporins is not suggested due to the high risk of new antimicrobial resistances	Weak recommendation against the intervention. Evidence quality: C
Should the prophylactic antibiotic be changed after a breakthrough UTI in children already on prophylaxis?	There is insufficient evidence to recommend changing the prophylactic antibiotic after a breakthrough UTI in children already on prophylaxis.	Weak recommendation. Evidence quality: D
Which dosage should be preferred for continuous antibiotic prophylaxis?	There is insufficient evidence to recommend a specific dose for continuous antibiotic prophylaxis. Doses from one-quarter to one-third of the standard treatment dosage may be appropriate	Weak recommendation. Expert opinion
Should antibiotic prophylaxis be continued in children undergoing pyeloplasty?	In the absence of other persistent risk factors, antibiotic prophylaxis may be discontinued after pyeloplasty.	Weak recommendation against the intervention. Evidence quality: C
How long should antibiotic prophylaxis be continued in children undergoing ablation of posterior urethral valves?	There is insufficient evidence to recommend how long antibiotic prophylaxis should be continued after ablation of posterior urethral valves.
How long should antibiotic prophylaxis be continued in children undergoing ureteral reimplantation?	There is insufficient evidence to recommend how long antibiotic prophylaxis should be continued after ureteral reimplantation.
How long should antibiotic prophylaxis be continued in children undergoing endoscopic treatment of VUR?	There is insufficient evidence to recommend how long antibiotic prophylaxis should be continued in children undergoing endoscopic treatment of VUR. According to recommendations 3 and 4, antibiotic prophylaxis is not routinely recommended in children with VUR of any grade.