SLR - April 2015 - Ciara M. Nicholson

Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial

Reference: Lazaro-Martinez JL, Aragon-Sanchez J, Garcia-Morales E. Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial. Diabetes Care. 2014 Mar; 37: 789-95.

Scientific Literature Review

Reviewed By: Ciara M. Nicholson, DPM
Residency Program: Saint Vincent Hospital, Worcester, MA

Podiatric Relevance: The prospect of using antibiotics therapy alone in the treatment of osteomyelitis is an attractive option in that it avoids the pitfalls involved in surgical treatment, including biomechanical alterations. Conservative surgery combined with antibiotics is a promising consideration in treating diabetic foot osteomyelitis because it may reduce the changes in the biomechanics of the foot and reduce the duration of antibiotic therapy. Currently accepted guidelines suggest that the combination of antibiotics with surgical removal of the infected bone may cure the majority of diabetic foot osteomyelitis.
Methods: This study was a prospective randomized comparative trial, performed between January 1, 2010 and December 31, 2012. The trial population was of patients with diabetes who had received a diagnosis of neuropathic foot ulcers, complicated by osteomyelitis and was carried out at the Diabetic Foot Unit at the Complutense University of Madrid. Patients were randomized into one of two groups: the antibiotic group (AG) and the surgical group (SG). Antibiotics were given for a 90-day period in the AG group. The SG patients received conservative surgery with postoperative treatment for 10 days.

Results: Fifty-two patients met the inclusion criteria for this study. Twenty-five (48.1 percent) were randomized to the AG, and 27 (51.9 percent) to the SG. One patient belonging to the AG and five to SG dropped out of the study due to difficulties attending follow-up appointments, or for other personal reasons. Of those remaining in the trial, eighteen patients (75 percent) achieved primary healing in AG, and 19 (86.3 percent) in SG. The median time to healing was seven weeks for AG patients and six weeks for SG patients. Four patients belonging to AG required surgical intervention due to worsening of symptoms. No difference was found between the two groups regarding minor amputations.

Conclusion: The authors concluded that antibiotic therapy and surgical treatment had similar outcomes in relation to healing rates, time to healing, and short-term complications in patients with neuropathic forefoot ulcerations and osteomyelitis.   

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