A 4-Year-Old Boy Is Brought to the Clinic for Evaluation

A 4-year-old boy is brought to the clinic for evaluation of fever and pain with urination.  The fever began yesterday morning, and in the evening the patient would cry while urinating.  Ibuprofen improved his fever and pain, but he began to vomit this morning.  Medical history includes a febrile urinary tract infection at age 13 months that resolved after a course of antibiotics.  At that time, a renal and bladder ultrasound was normal.  Temperature is 39.1 C (102.4 F) .  Palpation elicits suprapubic and right-sided costovertebral angle tenderness.  Urinalysis reveals positive nitrites and leukocyte esterase.  A urine culture shows >100,000 colony-forming units/mL of Escherichia coli.  The patient is given antibiotics, and his symptoms resolve in 24 hours.  A repeat renal and bladder ultrasound is normal.  Which of the following is the best next step in management of this patient?

A) Abdominal and pelvic CT
B) Daily antibiotic prophylaxis
C) No additional management
D) Repeat urine culture in 4 weeks
E) Voiding cystourethrogram

Correct Answer:

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