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Antibiotics for treating chronic osteomyelitis in adults
Lucieni O Conterno1, Carlos Rodrigues da Silva Filho
1Department of General Internal Medicine and Clinical Epidemiology Unit, Marilia Medical School, Avenida Monte Carmelo 800, Fragata, Marilia, São Paulo, Brazil, 17519-030.
The Cochrane Database of Systematic Reviews
|July 10, 2009
Summary
Systemic antibiotic treatment for chronic osteomyelitis shows no significant difference in remission rates between oral and parenteral methods. Further research is needed to confirm findings on adverse effects and optimal treatment strategies.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Chronic osteomyelitis presents a persistent challenge with high recurrence rates (20-30%) despite current antibiotic and surgical treatments.
- Long-term management of chronic osteomyelitis often involves frequent therapeutic failures.
Purpose of the Study:
- To evaluate the efficacy of various systemic antibiotic regimens for treating chronic osteomyelitis in adults.
Main Methods:
- A systematic review of randomized and quasi-randomized controlled trials was conducted, searching multiple databases up to October 2008.
- Included trials focused on antibiotic treatments post-surgical debridement for adult chronic osteomyelitis.
- Data extraction and quality appraisal were performed independently by two authors, with data pooled using a fixed-effect model where appropriate.
Main Results:
- Eight small trials (228 participants) with often inadequate study quality were analyzed.
- No statistically significant difference in remission rates at 12+ months was found between oral and parenteral antibiotic administration (RR 0.94; 95% CI 0.78-1.13).
- Adverse events were less frequent with oral antibiotics (4.8%) compared to parenteral (15.5%), though not statistically significant (RR 0.40; 95% CI 0.13-1.22).
Conclusions:
- Limited evidence suggests antibiotic administration route (oral vs. parenteral) does not impact remission rates for sensitive bacteria.
- Confirmation is needed for the observed trends in remission and adverse effects.
- Insufficient evidence exists regarding optimal antibiotic duration or adjustments for bacterial species and disease severity in chronic osteomyelitis treatment.
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