The rationale for including osteopathic manipulative treatment in the management of infections: a hermeneutic review

ABSTRACT

Introduction

As the prevalence of drug-resistant infections continues to outpace the development of new antibiotics, we must explore all reasonable options for enhancing the effectiveness of existing anti-infectives. The emergence of novel pathogens without initial drug treatments or vaccines, typified by the severe acute respiratory syndrome coronavirus-2 pandemic, further underscores the need for non-pharmacologic adjunctive measures for infection management. Osteopathic manipulative treatment (OMT) may represent such an adjunct.

Areas Covered

PubMed, CINAHL, Google Scholar, Cochrane databases and relevant chapters of major osteopathic texts were searched for animal experiments, case reports, observational studies, non-randomized, and randomized trials pertaining to infection, OMT, and the complications or safety of OMT. OMT was associated with one or more of the following: decreased bacterial colony counts in lung tissue; changes in immunologic profiles manifested by significant differences dendritic cells and levels of IL-8, MCP-1, MIP-1a, and G-CSF; shorter durations of IV antibiotics; decreased length of hospitalization; decreased rates of respiratory failure and death; decreased post-surgical lengths of stay; and enhanced patient satisfaction.

Expert Opinion

Preliminary, lower-grade evidence suggests that OMT can improve some infection-related outcomes, and is safe. The role of OMT in infection management should undergo further controlled trials without delay.

KEYWORDS:

• Adjunctive therapy
• complementary therapy
• immunity
• infection
• osteopathic manipulative treatment
• outcomes

Article highlights

• The emergence of novel pathogens without initial pharmacologic countermeasure, along with the ongoing antimicrobial resistance crisis, underscore the need to explore all reasonable adjuncts for managing infections.

• Osteopathic manipulative treatment (OMT) refers to the therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. It is preceded by a palpatory musculoskeletal examination to detect specific types of somatic dysfunction.

• The goals of OMT are to improve blood flow and lymphatic drainage, reduce edema, and facilitate restoration of homeostasis-promoting structure function relationships.

• A literature review of Cochrane, CINAHL, Google Scholar, and PubMed provides preliminary evidence, including randomized control trials, suggesting that adjunctive OMT can improve some infection-related outcomes.

• OMT decreased bacterial colony counts in lung tissue; changed immunologic profiles based on dendritic cells and levels of IL-8, MCP-1, MIP-1a, and G-CSF.

• OMT shortened durations of IV antibiotics, decreased length of hospitalization, rates of respiratory failure and death, and enhanced patient satisfaction.

• OMT should undergo confirmative investigations without delay.

Declaration of interest

No potential conflict of interest was reported by the author(s).