Dr. Rakesh Radheshyam Gupta
Child Health
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My child had fever two weeks back. The reports showed bacteria in the urine. He took Cefixime, and his fever subsided. But the fever recurred after two weeks. I have attached the reports. Please resolve my following doubts:
1. Why did the fever subside after taking Cefixime if the urine infection is still present?
2. Earlier white blood count was 15400 per microliter and now 20890 per microliter, the neutrophil count was 6100 per microliter, and now it is 7180 per microliter, lymphocyte count was 3500 in every 1 microliter of blood, and now it is 1840 in every 1 microliter of blood, pus cell count was 8 to 10, and now it is 5 to 6, nitrite was nil and it is present, and epithelial cells were nil and now they are 1 to 2.
3. Why some values have increased even after taking Cefixime?
Hi,
Welcome to icliniq.com,
I understand your concern.
From the reports attached (attachment removed to protect the patient's identity), I think this could be an improperly treated urine infection. First, we should also do a urine culture and a urine routine test. This shows the organism causing the disease and the antibiotics useful for it. I would suggest a urine culture. Also, record the temperature. Antibiotic therapy should be given for seven to ten days.
Patient's Query
Hi doctor,
I have attached the reports of the urine culture done two weeks back, and antibiotic therapy was started. Another urine culture was done today, but the reports will be available only after two to three days.
Hi,
Welcome back to icliniq.com.
I understand your concern. I have reviewed the report (attachment removed to protect the patient's identity).
1. For how long was Cefixime given? This could be some other infection.
2. How is the child's activity?
3. Are there any other symptoms?
4. What is the fever pattern?
Patient's Query
Hi doctor,
Cefixime was given for seven days as per dosage and was then stopped. After Cefixime was halted for three days, the fever recurred.
Also, what other infection do you think this can be?
The child has been active since yesterday, but since yesterday night, the fever has resumed. The child is active with no fever but becomes dull after four to five hours. No other symptoms are present other than a mild cold that started last week.
Hi,
Welcome back to icliniq.com.
I understand your concern.
As you mentioned, the child is active in intervals when there is no fever. This could be a sign of viral infection as well. Just monitor the temperature and maintain a record. Also, start some multivitamins such as syrup A to Z, 5 ml twice daily. I would advise watching the child's activity for the next 48 hours.
Patient's Query
Hi doctor,
The child is already on multivitamins and has frequently developed mouth ulcers since childhood.
As I have shared that two weeks back, the urine culture showed Klebsiella pneumoniae in the report.
1. Do you think it was because Cefixime was stopped after seven days?
2. Did the infection recur?
3. Is it normal for a bacterial infection to take this much time generally?
Hi,
Welcome back to icliniq.com.
I understand your concern.
Cefixime was sensitive as per the culture report (attachment removed to protect patient's identity). Seven days is a good time interval to cure the urinary infection. The child must have been fever-free three to four days after starting Cefixime.
So this may or may not be a urinary infection again. Just give it some time and follow my suggested instructions, such as observing the child's activity and temperature. If the child is active, then there is no need to worry. Usually, seven days of therapy is sufficient to cure urine infection.
Patient's Query
Hi doctor,
I have attached the new urine culture report.
Hi,
Welcome back to icliniq.com.
I understand your concern.
The report (attachment removed to protect the patient's identity) shows the same species as mentioned earlier, with a colony count of more than 100000.
I would suggest intravenous (IV) antibiotics as per the sensitivity report, such as IV Ceftriaxone for seven days or oral Co-trimoxazole (Trimethoprim and Sulfamethoxazole) if the child is active and playful. Consult your specialist doctor to discuss with them and take the medicines with their consent. I would also suggest a USG (ultrasonographysonography).
Patient's Query
Thank you, doctor, for the reply.
Do you think the reason for recurrence is that the antibiotics were not taken for an extended period and were abruptly stopped?
Hi,
Welcome to icliniq.com.
I understand your concern.
This could have happened after starting Cefixime, the patients responded to the drug, fever subsided, and activities improved. Generally, antibiotics are stopped after seven to ten days of administration. As per the previous urine culture report, it showed sensitivity to "Cefixime." But many aspects of antibiotic action inside the body are unknown. Antibiotics may not be 100 % sensitive inside the body even if they show good sensitivity in laboratory culture. I would suggest USG (ultrasonography) check for reflux.
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Child Health
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