Throwing a Bone to the C-Reactive Protein Level for Monitoring Osteoarticular Infections

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While the C-Reactive Protein (CRP) is not pathognomonic for any specific disease, its decline over time is often used as an indicator of clinical improvement in children with bone and joint infections. So how good is this serologic marker? Arnold et al. (doi: 10.1542/peds.2012-0220) share the results of their review of eight years of pediatric patients with osteoarticular infections and followed the course of the CRP with uncomplicated and complicated outcomes at the start of parental antibiotics as well as at the time of transitioning to oral medications. While clinical findings are certainly the most important sign of improvement, the CRP may yield some additional information in determining when to make the switch from IV to oral therapy. The results of this sizable 8 year case series may have you in joint agreement with the authors that the CRP over time can be quite helpful therapeutically.