Systemic antibiotic therapy for chronic osteomyelitis in adults

Area of Science:

• Infectious Diseases
• Pharmacology
• Orthopedic Surgery

Background:

• The standard treatment for chronic osteomyelitis involves 6 weeks of intravenous (IV) antibiotics.
• Growing evidence supports the efficacy of oral antibiotics in achieving adequate bone penetration for osteomyelitis treatment.
• Current literature features more studies on oral antibiotic therapy compared to parenteral routes for chronic osteomyelitis.

Purpose of the Study:

• To evaluate the comparative efficacy and safety of oral versus parenteral antibiotic therapy for chronic osteomyelitis.
• To explore the role of adjunctive therapies, such as rifampin, in improving treatment outcomes.
• To address the uncertainty surrounding optimal treatment duration and the necessity of prolonged antibiotic courses.

Main Methods:

• Systematic review and meta-analysis of published studies comparing oral and parenteral antibiotic regimens for chronic osteomyelitis.
• Analysis of cure rates, adverse events, and treatment costs associated with different antibiotic administration routes.
• Assessment of the impact of antibiotic duration and the potential benefits of adjunctive rifampin.

Main Results:

• Oral and parenteral antibiotic therapies demonstrate comparable cure rates for chronic osteomyelitis.
• Oral antibiotic therapy presents advantages including reduced risk of complications associated with IV catheters and lower overall costs.
• Adjunctive rifampin may potentially enhance cure rates when added to other antibiotic treatments.

Conclusions:

• Oral antibiotic therapy is a reasonable and cost-effective alternative to parenteral therapy for chronic osteomyelitis caused by susceptible pathogens.
• Current evidence does not support antibiotic durations exceeding 4-6 weeks, and prolonged treatment may contribute to antibiotic resistance.
• Further research is needed to define optimal treatment durations, routes, and the role of surgical debridement in managing chronic osteomyelitis.