Objective To evaluate the clinical efficacy of norvancomycin in pediatric patients with infection-related acute hematogenous osteomyelitis (AHO) and its impact on inflammatory markers.

Methods This retrospective analysis included 210 pediatric patients with infection-related AHO admitted to Hebei Children's Hospital from January 2016 to December 2024. Patients were divided into the vancomycin group (Group A, n = 103) and the norvancomycin group (Group B, n = 107) based on medication regimens. Baseline characteristics, including age, gender, weight, and lesion location, were adjusted for confounding factors using propensity score matching and multivariate regression analysis. Clinical efficacy and changes in inflammatory markers were compared between groups, including white blood cell (WBC) count, neutrophil (NE) count, C-reactive protein (CRP), and serum amyloid A (SAA) levels.

Results There was no statistically significant difference in clinical cure rates between the two groups (P > 0.05). At 1 and 3 weeks post-treatment, CRP and SAA levels showed statistically significant time effects (F_time-point = 503.00 and 703.400, respectively, P < 0.05). Both WBC and NE levels showed statistically significant time effects and between-group effects (F_time-point = 259.100 and 203.500, respectively; F_{between-group} = 8.403 and 6.884, respectively; P < 0.05), WBC, NE, CRP, and SAA levels gradually declined at both 1 week and 3 weeks post-treatment (P<0.05). Group A had higher WBC levels than Group B at 1 week post-treatment (P<0.05) and higher NE levels at 3 weeks post-treatment (P<0.05). The time required for WBC and NE to return to normal levels was longer in Group A than in Group B (t=2.051, 2.001, P<0.05), while the difference in recovery time for CRP and SAA between the two groups was not statistically significant (P>0.05). Group A had a longer duration of fever resolution than Group B (t=2.010, P<0.05). No statistically significant intergroup difference was observed in the time to resolution of clinical symptoms such as pain and swelling (P>0.05). The overall incidence of adverse reactions was 14.56% in Group A and 7.48% in Group B, with no statistically significant intergroup difference (P>0.05). The per-patient treatment cost and cost-effectiveness ratio were higher in Group A than in Group B (t=14.385, P<0.05).

Conclusion Norexvancomycin achieved clinical cure rates comparable to those of vancomycin in treating infection-associated AHO. Furthermore, it demonstrated advantages in accelerating the recovery of WBC and NE counts and the resolution of fever. These clinical benefits were coupled with lower per-patient costs and more favorable cost-effectiveness ratios compared to vancomycin.