For an 18‑month‑old who completed antibiotics for a first febrile UTI and is asymptomatic, which management option is MOST appropriate?

• A. Monitor with urine dipstick testing for recurrent infections until imaging results are known
• B. Obtain VCUG only if renal ultrasound is abnormal
• C. Obtain VCUG if a second febrile UTI occurs
• D. Administer daily antibiotic prophylaxis until RUS and VCUG results are known

Answer: (C)

Managing a toddler after a first febrile UTI focuses on identifying any urinary tract abnormalities while avoiding unnecessary invasive testing after just one event. The most appropriate plan is to perform a VCUG only if a second febrile UTI occurs. This approach aligns with how VUR and other abnormalities are evaluated: VCUG is reserved for recurrence or when imaging (like ultrasound) raises suspicion, because many children do well without immediate invasive testing after a single UTI. If a second febrile UTI happens, VCUG can reveal whether vesicoureteral reflux is present and guide further management.

Prophylactic antibiotics after a single UTI are not routinely recommended for all children, and using urine dipstick monitoring alone isn’t a reliable strategy to determine imaging needs. If ultrasound after the first UTI were abnormal, VCUG might be considered sooner, but the best choice given the current scenario is to proceed with VCUG only if a second febrile UTI occurs.