Rosh Pediatrics Practice Exam

After effective treatment of a persistent fever and confirmed urinary tract infection in a 21-month-old girl, what clinical intervention is most appropriate?

1. Daily nitrofurantoin

2. Observation until age 2 years

3. Surgical correction

4. Ureteral stent placement

The correct answer is: Daily nitrofurantoin

In the case of a persistent fever and confirmed urinary tract infection (UTI) in a young child, the goal of treatment is not just to address the immediate infection but also to prevent future occurrences. Daily nitrofurantoin is an appropriate clinical intervention following successful treatment of the initial UTI in this scenario, especially since recurrent UTIs are relatively common in young children. Nitrofurantoin is an antibiotic that is particularly effective against the bacteria typically associated with urinary tract infections. By providing prophylactic treatment with nitrofurantoin, the risk of recurrent infections can be significantly reduced, allowing for better management of the child’s health. While monitoring the child is also important, just observing until she reaches age 2 without any intervention may leave her vulnerable to further UTIs. Surgical correction and ureteral stent placement are more invasive options that are generally reserved for specific anatomical issues or severe complications, which would not be warranted in a simple case of recurrent UTIs without evidence of anatomical anomalies. Hence, daily nitrofurantoin serves as both a preventive measure and an appropriate follow-up intervention in this context.