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Febrile UTI infant — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)Febrile UTI infantUSMLE Step 3

A 28-week pregnant patient has fever 39.1°C, flank pain, costovertebral-angle tenderness and pyuria. Blood pressure is stable. Which management is most appropriate?

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Correct answer: E — Use inpatient parenteral antibiotics, then active oral therapy to complete 14 days

The best answer is “Use inpatient parenteral antibiotics, then active oral therapy to complete 14 days”. Pyelonephritis in pregnancy is initially treated in hospital because maternal and obstetric deterioration can be rapid. Parenteral therapy continues until improvement, followed by an active oral drug for a total of 14 days; nitrofurantoin and fosfomycin lack renal tissue penetration.

Reference: ACOG Clinical Consensus: Urinary Tract Infections in Pregnant Individuals: https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/08/urinary-tract-infections-in-pregnant-individuals