CRP in monitoring antibiotic therapy |
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If severe bacterial infection is suspected, antibiotic therapy is normally started immediately even if
CRP or other inflammation markers are not elevated. As the induction of CRP synthesis in the liver has
a lag period of 6-12 h, it is not possible to detect infection during the first hours after its onset.
CRP values within the reference range in serial assays at 24 h and 48 h have been shown to be reliable
evidence allowing discontinuation of antibiotic therapy in neonates with suspected septicaemia. With
blood culture, septicaemia can not be excluded until after 48-72 h of incubation.
Monitor the CRP concentration daily
Serial CRP determination is the most useful means of monitoring patients for complications during
antimicrobial treatment of bacterial infections. The amount of CRP in the bloodstream follows the
circulating levels of inflammatory lymphokines with a lag of a few hours. Lymphokine secretion by
activated leukocytes decreases soon after pathogens have been eliminated and the situation has normalised.
If, however, treatment is not successful, the CRP level remains high for several days and may even
increase if the infection takes a turn for the worse. Monitoring serial CRP values can alert the physician
to complications and predict the outcome earlier than clinical signs, for instance. CRP measurements have
even proved to be useful in clinically challenging conditions complicated by neutropenia and immunosuppression.
Requirements for monitoring the course of an illness by CRP assay:
- Quantitative measurement of CRP concentration in serum
- Taking whole blood samples by finger pricks or from the heel makes serial sampling less unpleasant for infants.
- The test results should be available rapidly, preferably within one hour. If the clinician receives the result
the next day, most of the informative value of the CRP test is available too late.
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