| | When to perform | Comments |
Clinical evaluation: - Temperature
- Pain and range of movement
- Localized swelling or erythema
| - At least daily during admission
- Every 1 to 2 weeks after discharge
| - Worsening or failure to improve may indicate:
- Development of a complication
- Unusual or resistant pathogen
- Polymicrobial infection
- Inadequate dose of antimicrobial agent, or failure to administer it
- A diagnosis other than osteomyelitis
|
| CRP and ESR | - CRP: During admission:
- Every 2 to 3 days until ≥50% reduction or steady decline has occurred, then weekly if child remains hospitalized
- If clinical status worsens
- Weekly during outpatient follow-up
- ESR: On admission and before stopping antimicrobial therapy*
| - Highly elevated CRP after ≥4 days of treatment may be associated with prolonged symptoms of progression of radiographic changes
- ESR is usually at its highest 2 to 3 days after beginning antimicrobial therapy and declines slowly
- We continue antibiotic therapy for 4 weeks or until CRP and ESR are normal, whichever is longer*
|
| CBC with differential | - Before switch to oral therapy if WBC count is elevated at time of diagnosis
| - The WBC count is elevated at diagnosis in approximately one-third of children with osteomyelitis
- It usually normalizes within 7 to 10 days of initiation of effective antimicrobial therapy
|
- Weekly in children receiving beta-lactam antibiotics (eg, penicillins, cephalosporins)¶
- Weekly for in children receiving linezolid for >2 weeks
| - Adverse effects of beta-lactam drugs and linezolid include pancytopenia and leukopenia
|
| Serum antibiotic concentrationsΔ | - May be useful if poor absorption of antibiotic or failure to administer it are suspected
| - Rare patients have inadequate serum concentrations despite high doses of antimicrobials
|
| Biochemical profile (including serum aminotransferases) | - Weekly if the patient is receiving penicillin antibiotics or intravenous cephalosporins
| - Adverse effects of beta-lactam drugs include impaired liver or renal function, and antibiotic-associated diarrhea
|
| Radiographs | - If the clinical status worsens or fails to improve
| - To assess complications:
- Soft tissue, subperiosteal, or intramedullary abscess
- Sinus tract
- Sequestra
- Pathologic fracture
- Additional imaging, usually with MRI, may be necessary
|
- Before discontinuation of antimicrobial therapy
| - To ensure that there are no new bone lesions (eg, devitalized bone, lytic lesions)
|
