What to do in a case of recurrent U.T.I.? USG---NAD, UTI COMING EVERY 3-6 MTHS. AGE IS 5 YRS. WHAT WILL BE THE DOSE OF NITROFURANTOIN? A child has been bitten by a dog(street dog)6 weeks ago. What to do? A pre-exposure or post -exposure anti rabies vaccine to be given? Is pneumo-23 vaccine needed in a child with cirrhosis of liver with huge splenomegaly?how many doses and at what interval?

A case of recurrent UTI with normal USG would require an MCU to rule out VUR. A DMSA csan after 3 months after the acute episode of UTI may be required to look for renal scars. In the meantime prophylcatic antibiotics in the form of Septran (2 mg/kg HS) or Nitrofurantoin may be advised.

A child bitten by a street dog 6 weeks ago would still require Anti rabies vaccine if the dog is not seen again in the same schedule as post exposure prophylaxis i.e Day 0,3,7,14,30 and 90.

Penumococcal vaccine may be required in a child with portal hypertension if there is evidence of hypersplenism. Also to control the portal hypertension, if spenectomy is required with shunt surgery, pneumococcal vaccine is advised. Otherwise a huge spleen is not an indication. The uncomjugated vaccine is available in India and only one dose needs to be given at least 2 months prior to splenectomy.