In a patient with cough, low-grade fever, and difficulty swallowing, what is the best next step after starting antibiotics?

In a scenario involving a patient with cough, low-grade fever, and difficulty swallowing, the presentation suggests a potential esophageal or upper airway complication that may be contributing to these symptoms. After initiating antibiotics, the next best step is to perform a barium swallow study.

This imaging technique is particularly useful in assessing the anatomy and function of the esophagus and can help identify potential obstructions, strictures, or motility problems that might be causing the swallowing difficulty. It provides critical information about how food moves through the esophagus, which is vital in understanding the underlying cause of the patient's symptoms.

Conducting a repeat chest x-ray may not provide additional information pertinent to the symptoms related to swallowing difficulties, as it primarily assesses for lung-related issues. Referring the patient to gastroenterology could be important, but it is more appropriate after initial diagnostic studies are completed. Similarly, starting oral steroids might be indicated for inflammatory conditions but does not provide the immediate clarification needed regarding the swallowing issue. Therefore, the barium swallow study is the most logical next step following the initiation of antibiotics.