Impact of antibiotic duration in management of diabetic foot osteomyelitis: A systematic review and meta-analysis

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Background Antibiotics remain a mainstay of therapy for diabetic foot osteomyelitis (DFO), but optimal duration of therapy remains unclear. Objectives To evaluate the effect of duration of antibiotic therapy on treatment success for DFO. Data Sources Medline, EMBASE and Cochrane CENTRAL databases were utilized to search for eligible studies from inception to 31 December 2024. Study eligibility criteria We included studies that reported antibiotic therapy duration and treatment outcomes for treatment of DFO. Participants Patients receiving antibiotic therapy for treatment of DFO. Interventions Antibiotic therapy Assessment of risk of bias The Joanna Briggs Institute critical appraisal tools were used. Methods of data synthesis Random-effects meta-analysis was used to assess the pooled treatment success rates for ≤6 weeks and >6 weeks antibiotic therapy. Treatment success by treatment modality and study design were also assessed. Results 33 studies, including 6 RCTs and 27 observational cohorts were included in this review. The pooled treatment success rate was 74% (95% CI: 69%, 80%) for both patients receiving ≤6 weeks and >6 weeks antibiotic therapy. Included RCTs demonstrated pooled success rates of 65% (95% CI: 49%, 80%) and 74% (95%CI: 62%, 85%) for ≤6 weeks and >6 weeks antibiotics respectively. There was only minor difference between patients receiving antibiotic therapy alone (73%, 95% CI: 62%, 82%) versus combined antibiotics with surgical therapy (75%, 95% CI: 66%, 82%). Heterogeneity was high (I 2 = 90%). Conclusions Although treatment success rates were equivalent for varying durations of antibiotic therapy, high heterogeneity in study design makes these results difficult to translate to clinical practice. Standardizing study design for future research and allocating treatments by risk profile will be essential for improving understanding of DFO therapy.