Reviewed by Shipra Gupta, MD, MS, Children’s Hospital at Montefiore
Bottomline- This study found that antibiotic-related lab abnormalities occurred in 13.3% of children treated for acute osteomyelitis, mainly among those on outpatient IV antibiotics like vancomycin or linezolid, suggesting targeted rather than routine lab monitoring may be more effective.
This retrospective study examined the frequency and clinical relevance of antibiotic-related laboratory abnormalities (ARLA) in children with acute hematogenous osteomyelitis (AHO) who completed therapy as outpatients. Among 240 patients with appropriate follow-up labs, 13.3% developed ARLA—primarily neutropenia (5.9%), thrombocytopenia (3.2%), AST/ALT elevation (12.1%), and acute kidney injury (2.2%). ARLA was more common in patients receiving outpatient parenteral antimicrobial therapy (OPAT), especially those treated with vancomycin or linezolid. Most ARLA cases were mild and did not affect clinical management, though they often triggered repeat lab testing. The findings suggest that routine outpatient monitoring may be unnecessary for children on oral antibiotics without prior toxicity. Instead, a targeted monitoring approach is recommended—focused on those receiving OPAT, with prior lab abnormalities, or on higher-risk antibiotics. The study supports guideline preferences for early oral therapy and raises questions about the utility and cost-effectiveness of widespread lab monitoring.
Reference:
Rosiji FO, et al. Outpatient Laboratory Monitoring for Antibiotic-related Adverse Events in Children With Acute Hematogenous Osteomyelitis. PIDJ 2025. https://doi.org/10.1097/inf.0000000000004576