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How Long Should the Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis Be?

Six weeks may be just enough….

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

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.

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). The researchers 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).

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

Practice Pearl:

  • The 6-week duration antibiotic therapy for non-surgically diabetic foot osteomyelitis had very similar outcomes to the 12-week period.

Alina Tone. Six-week versus twelve-week antibiotic therapy for nonsurgically treated diabetic foot osteomyelitis: A multicenter open-label controlled randomized study. Diabetes Care, pub online before print November 20, 2014, doi: 10.2337/dc14-1514