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Levels of serum alkaline phosphatase (ALP) and the hepatic enzyme ALT are used to monitor medication toxicity [1]. ALP is important in osteoarticular processes because, excluding the liver, the highest concentrations of this enzyme can be found in the bone [1, 2]. High doses of clindamycin and first-generation cephalosporins have cytotoxic effects against osteoblasts in vitro [3-5]. The serum concentration of bone-specific ALP reflects the cellular activity of osteoblasts, and ALP elevation is encountered during bone formation or increased bone turnover [2, 6]. Furthermore, high ALP concentrations are found under septic conditions [2, 6-8]. ALP values are age and gender specific and vary throughout infancy and puberty [6].

Repeated Serum Alkaline Phosphatase Measurements in the Treatment of Childhood Acute Bone and Joint Infections with High Doses of Antibiotics