Treating Patients with Diabetic Foot Osteomyelitis

Abigail Zuger, MD reviewing Tone A et al. Diabetes Care 2015 Apr.

Is surgical debridement always necessary? In carefully selected patients, perhaps not.

When osteomyelitis complicates diabetic foot infections, amputation or aggressive surgical debridement usually is recommended. When neither of these options is possible, prolonged antibiotic courses are substituted. Unfortunately, no one knows exactly how long a course is long enough.

Researchers in France randomized 40 diabetic adults with biopsy-confirmed osteomyelitis of the foot to treatment with either 6 or 12 weeks of antibiotics alone, without surgery. Most patients had infection of one of the metatarsal heads. Antibiotic selection was dictated by culture results of biopsy specimens, and antibiotics were administered orally for all but the first few days of treatment. No patient had evidence of vascular disease, none had gangrene, and those for whom surgical intervention was clearly mandated because of bone or joint destruction were excluded.

Twelve months after completing treatment, 12 patients in the 6-week group and 14 in the 12-week group were considered to be cured — this difference was not significant. No clinical or microbiological parameters were identified that might have predicted treatment failure among the remaining 14 patients. Antibiotic side effects, mostly gastrointestinal, were more common in the 12-week group.

CITATION(S):

Tone A et al. Six-week versus twelve-week antibiotic therapy for nonsurgically treated diabetic food osteomyelitis: A multicenter open-label controlled randomized study. Diabetes Care 2015 Apr; 38:302.