Antibiotics May Be as Effective as Surgery in Treating Foot Osteomyelitis

A recent study found that surgery may not always be the best course of action to treat people with diabetes who have foot osteomyelitis.

An infection of the bone, osteomyelitis is the most frequent foot infection associated with diabetes, accounting for 10 to 25 percent of mild infections and almost 50 percent of severe infections.

The infections have traditionally been treated by the surgical removal of all the infected bone, but a recent study suggests that a course of antibiotics can also be effective.

Conducted by researchers at the University of Madrid in Spain, the study found that 75 percent of those who took antibiotics and 86.3 percent of those who underwent surgery had healed within about 12 weeks, with the median healing time six weeks for those on antibiotics and seven weeks for those who had surgery.

Rates of minor amputations were the same for both groups.

According to researchers, led by Drs. J.L. Lázaro-Martínez and Javier Aragón-Sánchez, the results suggest that antibiotics are the best first course of action to treat infections such as foot osteomyelitis.

“Antibiotics and surgical treatment had similar outcomes in terms of healing rates, time to healing, and short-term complications in patients with neuropathic forefoot ulcers complicated by osteomyelitis without ischemia or necrotizing soft tissue infections,” they wrote.

The study appeared in a recent issue of the American Diabetes Association journal Diabetes Care.

Aragón-Sánchez had previously studied the benefits of antibiotics combined with conservative surgery to treat foot osteomyelitis in the International Journal of Lower Extremity Wounds.

“One of the main arguments used to justify the solely antibiotic treatment of osteomyelitis is the alteration of foot biomechanics produced as a consequence of surgery,” he wrote in 2012.”Conservative surgery combined with antibiotics is an attractive option in treating diabetic foot osteomyelitis because it may reduce the changes in the biomechanics of the foot and minimize the duration of antibiotic therapy.”

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