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Int J Antimicrob Agents. 2019 Jan 10. pii: S0924-8579(19)30007-X. doi: 10.1016/j.ijantimicag.2019.01.007. [Epub ahead of print]

Short- versus long-course antibiotics in osteomyelitis: A systematic review and meta-analysis.

Author information

1
Department of Medicine, College of Medicine, National Taiwan University, No. 1 Jen Ai Road, Taipei 100, Taiwan.
2
Department of Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA.
3
Department of Emergency Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan.
4
Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386 Dazhong 1st Road, Zuoying District, Kaohsiung City 813, Taiwan; Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, No. 452 Huanqiu Road, Luzhu District, Kaohsiung 821, Taiwan; Department of Orthopaedic Surgery, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Road, Neihu District, Taipei City 114, Taiwan.
5
Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan.
6
Department of Emergency Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan. Electronic address: hit3transparency@gmail.com.

Abstract

Current practice of long-term antibiotic use in patients with osteomyelitis is controversial. Recent studies showed short-term antibiotic use to be non-inferior to long-term use, but the results of these studies have been inconsistent. In this review, the PubMed and Embase databases were searched from inception through to June 2018 for randomised controlled trials (RCTs), cohort studies or case-control studies comparing two different durations of antibiotic use. Short antibiotic courses were defined as antibiotics administered for a shorter period than the recommended 4-6 weeks. A random-effects model was used to calculate summary odds ratios (ORs) of treatment failure in patients treated with short-course antibiotics compared with long-course antibiotics. A total of 15 articles (5 RCTs and 10 observational studies) and 3598 patients were included. The overall OR of treatment failure in patients receiving short-course antibiotics was 1.50 [95% confidence interval (CI) 0.97-2.34]. Subgroup analysis revealed that a short course of antibiotic treatment was associated with an increased treatment failure rate in vertebral osteomyelitis (OR = 2.06, 95% CI 1.18-3.57) while having a similar rate to a long antibiotic course in acute osteomyelitis of childhood (OR = 1.86, 95% CI 0.75-4.64). Meta-regression found a higher proportion of Staphylococcus aureus infection was related to a higher risk of treatment failure in patients with vertebral osteomyelitis (Coef. = 4.996; P = 0.032). Short-course antibiotics are safe and effective in children with acute osteomyelitis. Long-course antibiotics may still be preferred in vertebral osteomyelitis, especially in patients with S. aureus infection.

KEYWORDS:

Antibiotics; Osteomyelitis; Short-course therapy; Treatment duration

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