Followup management

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The PCDAI is a useful monitoring tool for disease activity, but it is time-consuming to use in a routine clinical setting.194-198 A numerical score (0-100) based on general well-being, clinical symptoms and objective measurements of weight, height and clinical examination, as well as laboratory tests provides an objective means to follow disease activity and response to therapy (Table

Table 23.12

Commonly used antibiotics for Crohn's disease

Antibiotic

Dosage

Side-effects

Metronidazole

30-50mg/kg per day, TID

metallic taste, disulfiram reaction with alcohol, peripheral neuropathy, potential birth defect

Ciprofloxacin

20-30mg/kg per day, BID

skin rash, headache, nausea, vomiting, renal failure, seizures, arthropathy

Augmentin

20-40mg/kg per day, TID

skin rash, nausea, vomiting, diarrhea, hypersensitivity reactions, seizures, interstitial nephritis

TID, three times a day; BID, twice a day

23.13). A score of 0-10 indicates inactive disease, 11-30 mild-to-moderate disease, and over 30 moderate-to-severe disease. Signs of pubertal development and nutritional assessment should be an important part of ongoing care. Annual ophthalmological examination is important for all patients who have been exposed to corticosteroids. In addition to dietary supplement of vitamin D and calcium to prevent development of osteopenia and osteoporosis, regular bone density study using DEXA is recommended for patients on prolonged corticosteroid therapy. There are no proven therapeutic interventions in children with Crohn's disease that have been shown to prevent recurrence of disease or maintain remission. Nevertheless, immunomodulator therapy and 5-ASA are often used in this role.

Table 23.13 Pediatric Crohn's Disease Activity Index (PCDAI) (adapted from reference 194)

History (recall, 1 week)

Score

Abdominal pain

None

0

Mild (brief, does not interfere with activities

5

Moderate (daily, prolonged, nocturnal, interfering with activities)

10

Stools (per day)

0-1 (liquid, no blood)

0

1-2 (semi-formed with small amount of blood)

5

or 2-5 (liquid)

> 6 (liquid or gross bleeding or nocturnal diarrhea)

10

Patient functioning, general well-being (recall, 1 week)

No limitation of activities, well

0

Occasional difficulty in maintaining age-appropriate activities

5

Frequent limitation of activity

10

Laboratory tests

Hematocrit (%)

< 10 years

value >33

0

28-32

2.5

<28

5

11-19-year-old girl

value >34

0

29-33

2.5

<29

5

11-14-year-old boy

value >35

0

30-34

2.5

<30

5

15-19-year-old boy

value >37

0

32-36

2.5

<32

5

ESR (mm/h)

< 20

0

20-50

2.5

>50

5

Albumin (g/dl)

>3.5

0

3.1-3.4

2.5

< 3.0

5

ESR, erythrocyte sedimentation rate

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