Treatment strategies for chronic osteomyelitis in low- and middle-income countries: systematic review.

OBJECTIVES: To identify a standard treatment regime or highly successful procedure for chronic osteomyelitis in low- and middle-income countries.

METHODS: Systematic review following PRISMA guidelines.

RESULTS: The initial search resulted in 102 studies of which nine met the inclusion criteria and were analysed qualitatively. The included studies involved 1173 patients from Africa and Asia. All patients were diagnosed with chronic osteomyelitis. Surgical and antibiotic treatment regimens differed substantially. No better judgement than moderate risk of selection bias could be made due to the study designs.

CONCLUSIONS: The evidence is not sufficiently robust to identify the most effective treatment, or to even allow a recommendation of the best suitable treatment of chronic osteomyelitis in low-income countries.