A Retrospective Cohort Study From 2 Academic Medical Centers: Oral vs Intravenous Antibiotics for Diabetic Osteomyelitis

Background: The Infectious Diseases Society of America guidelines recommend a prolonged course of antibiotics in the setting of residual osteomyelitis. More recently published literature suggests that oral antibiotics may offer comparable outcomes to intravenously administered antibiotics when treating orthopaedic infections. In a prior study, we investigated the outcomes of both routes of antibiotic administration in patients with diabetic foot infections at a single academic medical institution. Methods: The goal of this study is to retrospectively evaluate the therapeutic success in 196 patients receiving oral or intravenous antibiotics for treatment of residual infection following amputation at 2 academic medical centers. Treatment was considered successful if patients who completed a minimum of 4 weeks of antibiotic therapy had complete wound healing and did not require additional debridement or amputation within 1 year of their initial surgery. Results: After performing a retrospective chart review, no difference was determined in treatment success between patients who underwent oral or intravenous antibiotics at either WFBMC ( P = .34) or UPMC ( P = .99). No difference in success was found when combining institutional data ( P = .52). The median time to healing for oral antibiotics was 3.21 months compared with 3.85 months for intravenous ( P = .16). Reoperation rates did not differ among treatment types ( P = .53). Hemoglobin A 1c values were lower among patients with treatment success (8.6 ± 2.3) versus failure (9.5 ± 2.5) ( P = .016). Conclusion: This study supports the consideration of oral antibiotics as a viable option for selected diabetic patients with residual osteomyelitis. No significant differences were observed in treatment success, healing time, or reoperation rates, although the study was not powered to determine equivalence.