Background: Current guidelines for treatment of osteomyelitis (OM) suggest antibiotics for 3 to 6 weeks. However, recent studies provided conflicting evidences about the benefits of prolonged use of antibiotics. We conducted a systemic review and meta-analysis to assess the outcomes of short- and long-term antibiotics in patients with OM.
Methods: We used three queries to retrieve literature of vertebral OM, chronic OM and diabetic foot OM from PubMed and Embase databases until December 2017. Each query comprised medical subject headings, title/abstract keywords, and exclusion terms. Two reviewers independently screened literatures for three rounds and disagreements were resolved by a third reviewer. Quality of a cohort study and that of a randomized control trial (RCT) were assessed by Newcastle-Ottawa Quality Assessment Form and a modified Jadad scale respectively.
Results: 7,192 studies were retrieved (Figure 1). 11 observation studies and 5 RCTs were included for analysis, including 7 articles about vertebral OM, 2 chronic OM, 5 pediatric OM and 2 diabetic foot OM. Of the 11 observational studies, only 5 were graded as good or fair quality. 13 studies demonstrated no significant difference in outcomes between short- and long-term of antibiotics, while 3 studies showed favorable outcomes in patients taking long-term antibiotics. The aggregate odds ratio (OR) of mortality was 0.46 (95% CI, 0.21, 1.02) for observational studies and 0.90 (95% CI, 0.58, 1.41) for RCTs, showing no significant benefits of long-term antibiotics in patients with OM (Figure 2). In patients with vertebral OM, outcomes were comparable between short- and long-term of antibiotics (OR 0.51, 95% CI, 0.26, 1.01). In 7 studies where only intravenous (IV) antibiotics were used, there was no significant benefit of long-term antibiotics (OR 1.12, 95% CI, 0.68, 1.83). However, in the remaining 9 studies where antibiotics were transitioned from IV to oral form, there was marginal benefit of long-term oral antibiotics (OR 0.44, 95% CI, 0.22, 0.91).
Conclusion: Both RCTs and observational studies demonstrated that long-term antibiotics use did not generate significantly better outcome as compared to short-term antibiotics in patients with all-cause or specific type of OM.
H. T. Yen, None
C. C. Lee, None