Retrospective Comparison of Intravenous Therapy, Oral Therapy, and Lipoglycopeptides for the Treatment of Osteomyelitis

The use of Oral (PO) antibiotics and Lipoglycopeptides (LGP) is challenging the previous standard of Osteomyelitis (OM) treatment. This retrospective study included patients diagnosed with OM treated with Intravenous (IV) antibiotics, PO antibiotics, or LGP. The primary outcome was the occurrence of clinical failure within six months of therapy completion. Previous OM, surgical intervention as a part of management, presence of Staphylococcus aureus on culture, and other variables were included in a bivariate analysis, and variables with a p-value<0.2 were included in a multivariate regression. 257 patients received IV therapy, while the PO and LGP groups included 20 and 15 patients respectively. In the IV group, 89 (35%) of the patients experienced clinical treatment failure compared to 5 (25%) in the PO group and 5 (33%) in the lipoglycopeptide group (p = 0 .71). Median LOS was significantly shorter in the PO group compared to the IV and LGP groups [1 day (IQR 0-2.5) vs. 7 days (IQR 4-10) and 4 days (IQR 4-9), p = .003]. Only previous OM was included in the multivariate regression model [OR 1.75, 95% CI (1.07-2.87)]. Clinical outcomes were similar between the 3 groups. Previous OM at the index site being independently associated with treatment failure suggests that appropriate surgical intervention and antibiotic selection are of the utmost importance when managing OM. When feasible and appropriate, PO antibiotics and LGPs should be considered viable treatment options for OM.