Six-Week Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study

Toné, A.; Nguyen, S.; Devemy, F.; Topolinski, H.; Valette, M.; Cazaubiel, M.; Fayard, A.; Beltrand, E.; Lemaire, C.; Senneville, Éric

doi:10.2337/dc14-1514

Cited by 164 publications

(198 citation statements)

References 27 publications

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“…The study suggests that WBC-SPECT/CT predicts remission after a 6 or 12 week course of antibiotic treatment, and found that the overall remission rate was higher than most of the rates observed in the literature [4][5][6][7][8][9][10][11][12][13][14]. As is generally observed in studies dealing with DFO, the overwhelming majority of the population included in the present study had neuropathy and there was a high rate of chronic complications associated with long-term diabetes.…”

Section: Discussioncontrasting

confidence: 43%

“…Individuals with peripheral arteriopathy or renal insufficiency were not excluded in the absence of an indication for bone resection or amputation. As in recent randomised controlled studies on DFO [13,14], at least 40 participants were included, with a minimum of 20 participants treated for 6 weeks and 20 participants treated for 12 weeks, with an expected rate of DFO remission above 70%.…”

Section: Methodsmentioning

confidence: 99%

“…Based on these studies, the 2012 Infectious Diseases Society of America (IDSA), recommended more than 3 months' antibiotic treatment [1]. Tone et al in 2015 published the only randomised controlled study in this area, which compared 6 weeks with 12 weeks of treatment in 40 participants [14]. The remission rate was 60% in those treated for 6 weeks and 70% in those treated for 12 weeks.…”

Section: Introductionmentioning

confidence: 99%

“…Despite controversies in the management of DFO, the purely medical approach based on antibiotic therapy alone is efficient [2,3]. Indeed, the remission rate of DFO in those treated medically is reported to range from 53% to 82% [4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Application of white blood cell SPECT/CT to predict remission after a 6 or 12 week course of antibiotic treatment for diabetic foot osteomyelitis

et al. 2017

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Aims/hypothesis Diabetic foot osteomyelitis is a major risk factor for amputation. Medical treatment allows remission in 53-82% of cases. However, the optimal duration of antibiotic therapy remains controversial as a validated marker of osteomyelitis remission is lacking. The aim of this cohort study was to assess prospectively the remission rate of diabetic foot osteomyelitis medically treated using white blood cell (WBC)-single-photon emission computed tomography (SPECT)/computed tomography (CT) as a predictive marker of remission. Methods Individuals with diabetic foot osteomyelitis that was non-surgically treated between April 2014 and December 2015 were included. All participants were treated with antibiotics alone. WBC-SPECT/CT was performed at 6 weeks and antibiotic treatment discontinued if the clinical signs of soft-tissue infection had resolved and there was no abnormal uptake of labelled WBCs. Treatment was otherwise continued for a total of 12 weeks and then discontinued. For these individuals, another WBC-SPECT/CT was performed at 12 weeks. Remission was defined as the absence of recurrence of osteomyelitis at the same location at 1 year. Results Forty-five individuals were included; overall remission rate was 84% at 1 year. A 6 week course of antibiotics was used in 23 participants, 22 of whom were in remission at 1 year (96%); a 12 week course was used for 22 participants, 16 of whom were in remission at 1 year (73%). Sensitivity of WBC-SPECT/CT at 12 weeks was 100%, specificity 56%, positive predictive value 46% and negative predictive value 100%. Conclusions/interpretation The study suggests that WBC-SPECT/CT could predict remission at the end of antibiotic treatment.

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Section: Discussioncontrasting

confidence: 43%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Application of white blood cell SPECT/CT to predict remission after a 6 or 12 week course of antibiotic treatment for diabetic foot osteomyelitis

et al. 2017

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“…While possible, this indirect benefit remains to be established and even if it is, the limited availability of SPECT/CT will remain a barrier -at least in the short term. More trials are urgently needed to extend the important finding of Tone and colleagues that a 6 week course of antibiotics was not inferior to a longer one [11] and, in particular, to determine whether antibiotic courses of just 2 or 3 weeks may be as effective in the management of osteomyelitis as they can be in the management of soft tissue infection.…”

Section: Spect/ct Scanningmentioning

confidence: 99%

Osteomyelitis of the foot: non-surgical management, SPECT/CT scanning and minimising the duration of antibiotic use

Jeffcoate

2017

Diabetologia

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In a paper in this issue of Diabetologia (DOI: https://doi.org/10.1007/s00125-017-4417-x), Vouillarmet and colleagues have explored the use of single-photon emission computed tomography (SPECT)/computed tomography (CT) to define remission during non-surgical management of osteomyelitis of the foot. Their experience in a non-controlled observational study of 45 individuals was that a negative white blood cell-SPECT/CT scan is a reliable marker of remission, while a positive scan at the end of antibiotic treatment may be relatively useful in the prediction of future short-to medium-term relapse. These findings and conclusions are discussed in the light of current uncertainties relating to the diagnosis of bone infection and the lack of any tested measure that can be used to indicate either its presence or its persistence. In this respect, it is concluded that the value of this approach, and in which population, remains to be clearly established.

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Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults

et al. 2022

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IMPORTANCE Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. OBJECTIVE To construct a clinical guideline for pyogenic osteomyelitis management, with a new standard of evidence to resolve the gap between strength of recommendation and quality of evidence, through the use of a novel open access approach utilizing social media tools.

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Six-Week Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study

Cited by 164 publications

References 27 publications

Application of white blood cell SPECT/CT to predict remission after a 6 or 12 week course of antibiotic treatment for diabetic foot osteomyelitis

Application of white blood cell SPECT/CT to predict remission after a 6 or 12 week course of antibiotic treatment for diabetic foot osteomyelitis

Osteomyelitis of the foot: non-surgical management, SPECT/CT scanning and minimising the duration of antibiotic use

Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults

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