Patient's question:
8-year-old girl with pneumonia received intravenous fluids for four days, but her CRP levels rose from 8 to 25. Sixteen days ago, she had a high fever of 39°C at the Aerospace Hospital Pediatrics Department. After a thorough examination, it was diagnosed as bacterial fever, and she was given ceftriaxone for two days, but the fever did not subside. The doctor then suspected a viral fever and switched to azithromycin for six days, but the fever remained above 39°C. Her family closely monitored her for a day. Five days ago, she was transferred to the pediatric hospital's special expert internal medicine outpatient clinic. X-rays revealed lung shadows, confirming pneumonia. At that time, her CRP level was normal at 8. Since the fifth day of intravenous fluids, her fever began to subside starting from the third day. Yesterday, the doctor said her lungs had cleared up significantly. Today, during her second test, the CRP level was found to be 25. The doctor said there was still inflammation in her lungs but that intravenous fluids would no longer be needed tomorrow. He added that pneumonia cannot be cured solely with intravenous fluids and that she would need to take ceftriaxone for at least a week at home. I am very puzzled by one thing: since her CRP is high and indicates inflammation, why did her condition worsen after receiving ceftriaxone for four days?Previous Treatment and Effects:
- Five days ago, she was diagnosed with bacterial fever and given ceftriaxone for two days, but the fever did not subside.
- She was then switched to azithromycin for six days, but the fever remained above 39°C.
What kind of help do you need:
I want to understand what is happening and what I should do next.
Doctor's answer:
CRP is a non-specific indicator reflecting the disease. It indeed reflects how to split the infection, but CRP generally increases 4-6 hours after inflammation reappears and takes 36-50 hours to surpass its peak. Therefore, in your case, the first test was conducted during the CRP rise phase. Subsequent retesting after anti-inflammatory treatment may show CRP has already risen, but since the inflammation has not completely subsided, CRP remains high. This is why you might experience two phases of CRP decline.It is recommended to follow your doctor's advice and take oral antibiotics. Recheck CRP after one week of treatment.