Duration of post-surgical antibiotic therapy for adult chronic osteomyelitis: a single-centre experience

Rod-Fleury, Thierry ; Dunkel, Nathalie ; Assal, Mathieu ; Rohner, Peter ; Tahintzi, Phedon ; Bernard, Louis ; Hoffmeyer, Pierre ; Lew, Daniel ; Uçkay, Ilker

In: International Orthopaedics, 2011, vol. 35, no. 11, p. 1725-1731

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    Summary
    Purpose: The optimal duration of concomitant antibiotic therapy after surgical intervention for implant-free chronic osteomyelitis is unknown. No randomized data exist. Available recommendations are based on expert's opinion. We evaluated the duration of post-surgical antibiotic treatment related to remission of chronic osteomyelitis. Methods: This was a retrospective single-centre study at Geneva University Hospitals with a minimal follow-up of two years after treatment. We used multivariate logistic regression analysis with exclusion of pediatric cases and of implant-related chronic osteomyelitis. Results: A total of 49 episodes of implant-free chronic osteomyelitis in 49 adult patients were studied. The median number of surgical interventions was two (range, 1-10). The median duration of post-debridement antibiotic treatment was eightweeks (range, 4-14weeks). Thirty-nine patients (80%) were in remission after a minimal follow-up of twoyears. In multivariate logistic regression analysis, one week of intravenous therapy had the same remission as two to threeweeks (0.2, 0.1-1.9) or ≥ 3weeks (0.3, 0.1-2.4). More than sixweeks of total antibiotic treatment equalled ≤ six weeks (0.8, 0.1-5.2). Conclusions: In chronic osteomyelitis in adults, a post-debridement antibiotic therapy beyond six weeks, or an IV treatment longer than one week, did not show enhanced remission incidences. Prospective randomized trials are required to confirm this observation