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Might make a difference in weighing options if you could clarify the following:

- Which is the oral antibiotic given

- Which is the IV antibiotic you would have expected to be given

- Is there any suspicion of an issue with the absorption of an oral drug? You have already stated that there is no vomiting; is there a mal-absorption condition of suspicion thereof?


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From: Pediatric Emergency Medicine Discussion List <[log in to unmask]> on behalf of Kevin Schreiber <[log in to unmask]>
Sent: 05 February 2018 14:55
To: [log in to unmask]
Subject: Fever in Baby

Hello all,
It seems like we can never get away from this issue.
I am a Peds EM doc who also works in a peds practice.
Recently saw a vaccinated 2.5 month old baby girl with a known history of a
solitary kidney and possible bladder diverticulum who presented to me with
a URI symptoms and a tactile temp. Happy, Interactive, no vomiting.
In clinic had a temp of 38.7. Exam unremarkable except for mild
rhinorrhea.  Received TylenoI.  I explained to the family that I felt there
should go to the ER and if there was a suspicion for a UTI, they would need
admission for IV antibiotics.
In the ED, had a CBC, Electrolytes, Blood Culture, UA, UCX and CRP
CBC WBC=9.8, no left shift, BUN CREAT normal, Glucose 101, Crp 0.26
UA (suprabic) Leuk esterase 3+, Nitrite +
The baby was sent home with oral antibiotics, to follow up as an outpatient.
I was perplex and confused with the decision for no IV  antibiotics,
especially with the solitary kidney history, Would a normal CBC / CRP sway
your thought process?
Comments? Thoughts?
Thank!
Kevin Schreiber
PEM Attending

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