Treatment options for diabetic foot osteomyelitis

ABSTRACT

Introduction: Diabetic foot osteomyelitis therapeutical options are based on antibiotic therapy and surgical resection of the infected bone(s). Surgical and medical approaches of patients suffering from a diabetic foot osteomyelitis do not oppose but are complementary and need to be discussed as a tailored manner.

Areas covered: The aim of the present article is to discuss data issued from the most recent guidelines of the Infectious Diseases Society of America and the International Working Group on the Diabetic Foot on the management of the diabetic foot infection and from a search in the current literature using the terms diabetic foot osteomyelitis and treatment/therapy/therapeutical in both PubMed and Medline, restricted to the last five years.

Expert opinion: Surgical removal of the entire infected bone(s) has been considered in the past as the standard treatment but medical approach of these patients has now proven efficacy in selected situations. The current emergence of bacteria, especially among Gram negative rods, resistant to almost all the available antibiotics gradually augments the complexity of the management of these patients and is likely to decrease the place of the medical approach and to worsen the outcome of these infections in the next future.

KEYWORDS:

• Diabetic foot osteomyelitis
• antibiotic therapy
• surgery
• bone biopsy

Article Highlights

• Diabetic foot osteomyelitis are frequent (i.e., 20 to 60%) complications of infected diabetic foot ulcers

• Surgical resection of the infection bones is an important part of the treatment but is not systematically indicated as complications may arise following surgery, especially the so-called ‘transfer syndrome’

• Medical option characterized by the prescription of antibiotics directed against bacteria identified by the means of a reliable documentation (i.e., transcutaneous bone biopsy) without any bone resection can be considered in some selected cases

• The duration of the antibiotic therapy should not exceed 6 weeks

• The growing worldwide prevalence of multiresistant bacteria is likely to modify the balance between medical and surgical approaches for the management of such patients by favouring in the next future the indications of surgical resection of the infected bone tissues

This box summarizes key points contained in the article.

Declaration of interest

E Senneville has been an investigator for Novartis Pharma; served on the speakers bureau for Novartis Pharma, Pfizer, Sanofi-Aventis, Merck Sharp & Dohme, Bayer and Cepheid; and received travel support from Novartis Pharma, Pfizer, Sanofi-Aventis, Merck Sharp & Dohme and Bayer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.