Diabetic Osteomyelitis: Oral versus Intravenous Antibiotics at a Single Level 1 Academic Medical Trauma Center

• Published in: The Journal of foot and ankle surgery Vol. 63; no. 4; pp. 490 - 494
• Main Authors: Kipp, Jennifer A., LeSavage, Lindsay K., Evans, Joni K., Denmeade, Travis A., Blazek, Cody D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024
• Subjects: Academic Medical Centers; Administration, Intravenous; Administration, Oral; Aged; amputation; Amputation, Surgical; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; antibiotics; Diabetic Foot - drug therapy; Diabetic Foot - microbiology; Female; foot and ankle; Humans; infection; Male; Middle Aged; osteomyelitis; Osteomyelitis - drug therapy; Osteomyelitis - etiology; Osteomyelitis - microbiology; Retrospective Studies; Trauma Centers; Treatment Outcome; Wound Healing - drug effects; osteomyelitis; amputation; infection; 3; foot and ankle; antibiotics
• DOI: 10.1053/j.jfas.2024.03.003
• ISSN: 1067-2516; 1542-2224

Residual osteomyelitis is a frequent problem following surgical intervention for diabetic foot infection. The Infectious Disease Society of America guidelines recommend a prolonged course of antibiotics for treatment of residual osteomyelitis. Recent literature suggests oral antibiotic therapy is not inferior to IV therapy. The primary aim of this study was to evaluate treatment success in 128 patients receiving oral versus IV antibiotics for residual osteomyelitis in the diabetic foot after amputation at a Level 1 academic medical trauma center. Treatment success was defined as completion of at least 4 weeks of antibiotic therapy, complete surgical wound healing, and no residual infection requiring further debridement or amputation within 1 year of the initial surgery. Patients with peripheral arterial disease were excluded. A retrospective chart review was performed, and we found no statistically significant difference in treatment success between these two groups (p = .2766). The median time to healing for oral antibiotic treatment was 3.17 months compared to 4.06 months for IV treatment (p = .1045). Furthermore, there was no significant difference in group demographics or comorbidities, aside from more patients in the IV group having coronary artery disease (p = .0416). The type of closure and whether the infection was single or polymicrobial were also not associated with a difference in outcomes between the two treatment arms. The results of the present study suggest oral antibiotics for treatment of residual osteomyelitis are not inferior to IV therapy and may be more efficacious for certain patients regarding cost and ease of administration.