Six-week versus twelve-week antibiotic therapy for nonsurgically treated diabetic foot osteomyelitis: a multicenter open-label controlled randomized study.

Abstract

OBJECTIVE:

Little is known about the optimal duration of antibiotic therapy for diabetic foot osteomyelitis (DFO). This study sought to compare the effectiveness of 6 versus 12 weeks of antibiotic therapy in patients with DFO treated nonsurgically (i.e., antibiotics alone).

RESEARCH DESIGN AND METHODS:

This was a prospective randomized trial comparing 6- versus 12-week duration of antibiotic treatment. Remission of osteomyelitis during the monitoring period was defined as complete and persistent (>4 weeks) healing of the wound (if present initially), absence of recurrent infection at the initial site or that of adjacent rays, and no need for surgical bone resection or amputation at the end of a follow-up period of at least 12 months after completion of antibiotic treatment.

RESULTS:

Forty patients followed at five French general hospitals were randomized between January 2007 and January 2009, with 20 treated for 6 weeks and 20 treated for 12 weeks with antibiotics. The two groups were comparable for all variables recorded at inclusion in the study. Remission was obtained in 26 (65%) patients, with no significant differences between patients treated for 6 versus 12 weeks (12/20 vs. 14/20, respectively; P = 0.50). We did not identify any significant parameters associated with patient outcome. Fewer patients treated for 6 weeks experienced gastrointestinal adverse events related to antimicrobial therapy compared with patients treated for 12 weeks (respectively, 15 vs. 45%; P = 0.04).

CONCLUSIONS:

The present multicenter prospective randomized study provides data suggesting that 6-week duration of antibiotic therapy may be sufficient in patients with DFO for whom nonsurgical treatment is considered.

• Authors: Alina Tone, Sophie Nguyen, Fabrice Devemy, Hélène Topolinski, Michel Valette, Marie Cazaubiel, Armelle Fayard, Éric Beltrand, Christine Lemaire, Éric Senneville
• Journal: Diabetes care (Diabetes Care) Vol. 38 Issue 2 Pg. 302-7 (Feb 2015) ISSN: 1935-5548 [Electronic] United States
• PMID: 25414157 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Chemical References

• Anti-Bacterial Agents
• Fluoroquinolones
• Rifampin

Topics

• Amputation, Surgical (statistics & numerical data)
• Anti-Bacterial Agents (administration & dosage)
• Diabetic Foot (complications, drug therapy)
• Drug Administration Schedule
• Drug Therapy, Combination
• Female
• Fluoroquinolones (administration & dosage)
• Humans
• Male
• Middle Aged
• Osteomyelitis (complications, drug therapy)
• Prospective Studies
• Rifampin (administration & dosage)
• Treatment Outcome
• Wound Healing (drug effects)