Question

A 13 month old female presents to her doctor two weeks after being successfully treated for an uncomplicated febrile UTI. Since that time, a voiding cystourethrogram (VCUG) showed grade I reflux bilaterally, and a renal ultrasound showed normal kidneys. The patient's past medical history is otherwise unremarkable. On physical exam, the patient is afebrile. Urinalysis is negative for leukocyte esterase and nitrite and microscopic examination shows only occasional hyaline casts and squamous epithelial cells. What is the most appropriate next step in the management of this patient?

A. Culture urine monthly
B. Repeat renal ultrasound in one month
C. Begin antibiotic prophylaxis
D. Repeat VCUG in three months
E. Reassurance

Answer 1

Antibiotic prophylaxis option (c) is considered the most appropriate next step for a 13-month-old female with a history of UTI and grade I reflux, as it helps to prevent further infections and potential renal damage.

Step-by-step explanation:

A 13-month-old female with a history of uncomplicated febrile urinary tract infection (UTI) and grade I reflux has a follow-up that shows she is afebrile with a normal urinalysis except for occasional hyaline casts and squamous epithelial cells.

Given the current findings, antibiotic prophylaxis is often considered the most appropriate next step to prevent further UTIs, especially in the presence of vesicoureteral reflux, even if it is low-grade. Antibiotic prophylaxis aims to reduce the risk of recurrent UTI and potential renal damage that can be associated with repeat infections.

Options such as repeating renal ultrasound or VCUG are more invasive and less likely to be immediately beneficial, given the recent normal imaging results and the current absence of infection symptoms. Monthly urine cultures or immediate repeat imaging are not indicated without a current UTI.

Thus, regular follow-up and monitoring of the patient's condition on antibiotic prophylaxis would be recommended until otherwise clinically indicated.