Use of Oral Antibiotics for Diabetic Foot Osteomyelitis: A Systematic Review
Summary: This PRISMA-guided systematic review (MEDLINE/EMBASE to July 2024) analyzed 26 studies (4 RCTs, 22 observational, n=972 DFO patients) on oral antibiotics (monotherapy 73.8%, step-down 26.2%). Mean duration 95 days; follow-up 12 months. Complete resolution: 75% monotherapy, 56% step-down; overall 70%. Recurrence low (5%). AEs in 24% (mostly mild GI/liver); no deaths. Oral therapy comparable to IV for efficacy, with advantages in cost/accessibility; supports outpatient/low-resource use with stewardship.
Key Highlights:
- Efficacy: 70% complete/partial resolution; 22% no resolution/amputation.
- Safety: 44 AEs (mild); 2 discontinuations.
- Classes: Penicillins 44%, fluoroquinolones 17%.
- Limitations: Heterogeneity, few RCTs, reporting bias.
- Authors: Siddhartha Sood, Ryan Geng, Jihad Waked, Asfandyar Mufti et al.
Keywords: oral antibiotics, DFO, osteomyelitis, outpatient, stewardship, Siddhartha Sood, Ryan Geng, R Gary Sibbald