Issue: January 2021
Disclosures: The authors report no relevant financial disclosures.
December 04, 2020
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Antibiotic treatment for diabetic foot osteomyelitis can be safely shortened by half

Issue: January 2021
Disclosures: The authors report no relevant financial disclosures.
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The duration of antibiotic treatment for diabetic foot osteomyelitis can safely and effectively be reduced from 6 to 3 weeks, according to a study published in Clinical Infectious Diseases.

“Antibiotic stewardship in the field of diabetic foot osteomyelitis (DFO) is a major component of antibiotic overuse in the world,” Ilker Uçkay, MD, head of infectiology and clinical research in the department of orthopedics at the University of Zurich, told Healio.

Photo of a doctor checking a patient's foot
Antibiotic treatment duration for diabetic foot osteomyelitis can safely and effectively be reduced by half to 3 weeks.
Credit: Adobe Stock

To assess if antibiotic use for DFO could be reduced, Uçkay and colleagues performed a prospective, randomized, noninferiority, pilot trial, randomly assigning patients with DFO after surgical debridement 1:1 to receive either a 3-week or a 6-week course of antibiotic therapy. According to the study, the researchers compared outcomes between the groups using Cox regression and noninferiority analyses.

According to the study, among the 93 enrolled patients, 44 were randomly assigned to the 3-week arm and 49 to the 6-week arm. In the intention-to-treat (ITT) population, remission occurred in 37 (84%) of the patients in the 3-week arm compared with 36 (73%) in the 6-week arm (P = .21). The number of adverse events was similar in the two study arms (17/44 vs. 16/49; P = .51), as were the remission incidences in the per-protocol (PP) population (33/39 vs. 32/43; P = .26).

Ilker Uçkay

According to the study, the multivariate analysis revealed that treatment with the shorter antibiotic course was not significantly associated with remission (for the ITT population: HR = 1.1; 95% CI, 0.6-1.7; for the PP population: HR = 0.8; 95% CI, 0.5-1.4).

Uçkay said that no guidelines have recommended reducing antibiotic duration for DFO to 3 weeks, although individual physicians and surgeons do it. He hopes that expert panels will discuss the possibility in future.

“Very probably, the antibiotic administration for DFO can be reduced without compromising the outcome of therapy,” Uçkay said. “The bad outcomes in DFO are inherent to the disease and the comorbidities, and presumably less influenced by the duration of antibiotics. Further trials are absolutely necessary.”

Uçkay added, “The author group of this article encourages all colleagues to perform scientific trials investigating the potential to reduce unnecessary antibiotic use, which is a major international goal.”