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

Residual osteomyelitis is a frequent problem following surgical intervention for diabetic foot infection. The current Infectious Disease Society of America guidelines recommend 4-6 weeks of initial intravenous antibiotics for treatment of residual osteomyelitis. However, recent literature suggests oral antibiotic therapy is not inferior to intravenous therapy. The primary aim of this study was to evaluate treatment success in 128 patients receiving oral versus intravenous 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 antibiotic therapy, complete surgical wound healing, and no residual infection requiring further debridement or amputation within one 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=0.2766). Median time to healing for oral antibiotic treatment was 3.17 months compared to 4.06 months for intravenous treatment (p=0.1045). Furthermore, there was no significant difference in group demographics or comorbidities, aside from more patients in the intravenous group having coronary artery disease (p=0.0416). Type of closure and type of microbial infection was 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 intravenous therapy and may be more efficacious for certain patients regarding cost and ease of administration. LEVEL OF CLINICAL EVIDENCE: : 3.