312. Comparison of Short Course and Long Course of Antibiotics in Patients with Osteomyelitis: A Systemic Review and Meta-analysis
Session: Poster Abstract Session: Bone and Joint Infections
Thursday, October 4, 2018
Room: S Poster Hall
  • OM IDSA poster_Ronan Hsieh.pdf (2.5 MB)
  • 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.

    Ronan Hsieh, M.D.1, Chung-Yen Huang, M.S.2, Hung-Teng Yen, M.S.2 and Chien-Chang Lee, M.D., Sc.D.3, (1)Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, (2)Medicine, National Taiwan University, Taipei, Taiwan, (3)Emergency Medicine, National Taiwan University, Taipei, Taiwan


    R. Hsieh, None

    C. Y. Huang, None

    H. T. Yen, None

    C. C. Lee, None

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