Lázaro-Martínez JL, Aragón-Sánchez J, García-Morales E, et al.
Diabetes care. Date of publication 2014 Jan 1;volume 37(3):789-95.
1. Diabetes Care. 2014;37(3):789-95. doi: 10.2337/dc13-1526. Epub 2013 Oct 15.
Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis:
a randomized comparative trial.
Lázaro-Martínez JL(1), Aragón-Sánchez J, García-Morales E.
Author information:
(1)Corresponding author: José Luis Lázaro-Martínez, diabetes@ucm.es.
Comment in
Diabetes Care. 2014 May;37(5):e115.
J Bone Joint Surg Am. 2014 Nov 19;96(22):1923.
Diabetes Care. 2014;37(3):593-5.
Diabetes Care. 2014 May;37(5):e116-7.
OBJECTIVE: No prospective trials have been carried out comparing antibiotic
treatment alone with primarily surgical treatment in patients with diabetes and
foot osteomyelitis. The aim of the current study was to compare the outcomes of
the treatment of diabetic foot osteomyelitis in patients treated exclusively with
antibiotics versus patients who underwent conservative surgery, following up the
patients for a period of 12 weeks after healing.
RESEARCH DESIGN AND METHODS: Between 1 January 2010 and 31 December 2012, a
prospective randomized comparative trial (clinical trial reg. no. NCT01137903,
clinicaltrials.gov) of patients with diabetes who had received a diagnosis of
neuropathic foot ulcers complicated by osteomyelitis was carried out at the
Diabetic Foot Unit at the Complutense University of Madrid. Patients were
randomized into the following two groups: the antibiotics group (AG) and the
surgical group (SG). Antibiotics were given for a period of 90 days in the AG.
Patients in the SG received conservative surgery with postoperative antibiotic
treatment for 10 days.
RESULTS: Eighteen patients (75%) achieved primary healing in the AG, and 19
(86.3%) in the SG (P = 0.33). The median time to healing was 7 weeks (quartile
[Q] 1 to Q5, Q3-Q8) in the AG and 6 weeks (Q1-Q3, Q3-Q9) in the SG (P = 0.72).
The conditions of four patients from the AG worsened (16.6%), and they underwent
surgery. Three patients from the SG required reoperation. No difference was found
between the two groups regarding minor amputations (P = 0.336).
CONCLUSIONS: Antibiotic therapy and surgical treatment had similar outcomes in
terms of healing rates, time to healing, and short-term complications in patients
with neuropathic forefoot ulcers complicated by osteomyelitis without ischemia or
necrotizing soft tissue infections.
DOI: 10.2337/dc13-1526
PMID: 24130347 [Indexed for MEDLINE]
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