Dischargeable CRP Level in a 3-Year-Old Child After IV Antibiotics
In a 3-year-old child who has been afebrile for 48 hours with normal CBC after 5 days of IV antibiotics, antibiotics can be safely discontinued regardless of the absolute CRP value, as long as the CRP is in a decreasing trend. 1
Clinical Decision Framework
Primary Discharge Criteria (All Must Be Met)
- Afebrile for ≥24 hours (your patient meets this at 48 hours) 1
- Negative blood cultures at 48 hours 1
- Clinical stability with documented overall improvement including level of activity and appetite 1
- Normal CBC (your patient meets this criterion) 1
CRP Considerations
The absolute CRP value is NOT a discharge criterion in pediatric guidelines. 1 What matters is:
- Decreasing trend (which your patient demonstrates) 1, 2
- CRP typically peaks at 36-50 hours after inflammatory insult and then declines 1
- In neonatal studies, CRP <10 mg/L at 24-48 hours post-antibiotic initiation had 99% negative predictive value for ongoing infection 2
- However, for a 3-year-old with initial CRP of 220 mg/L, the absolute value at discharge is less important than the clinical picture and downward trajectory 1, 2
Specific Guidance for Your Case
Your patient meets all discharge criteria:
- ✓ Afebrile for 48 hours (exceeds the 24-hour minimum) 1
- ✓ Normal CBC 1
- ✓ 5 days of appropriate IV antibiotics completed 1
- ✓ CRP in decreasing trend 1, 2
Discharge is appropriate even if CRP remains elevated (e.g., 80-100 mg/L), provided it continues to decline and the patient remains clinically well. 1
Common Pitfalls to Avoid
- Do not wait for CRP to normalize before discharge - CRP can remain elevated for days after clinical resolution and may lag behind clinical improvement 1, 2
- Do not continue antibiotics based solely on elevated CRP in a clinically stable, afebrile child with negative cultures 1
- Do not discharge if fever recurs within the 48-hour observation period, even if CRP is declining 1