Short- versus long-course antibiotics in osteomyelitis: A systematic review and meta-analysis
Journal
International Journal of Antimicrobial Agents
Journal Volume
53
Journal Issue
3
Pages
246
Date Issued
2019-03-01
Author(s)
Huang, Chung Yen
Hsieh, Ronan W.
Yen, Hung Teng
Hsu, Tzu Chun
Chen, Chun Yu
Abstract
© 2019 Elsevier Ltd 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.
Subjects
Antibiotics | Osteomyelitis | Short-course therapy | Treatment duration
Antibiotics; Osteomyelitis; Short-course therapy; Treatment duration
SDGs
Other Subjects
antibiotic agent; antiinfective agent; cholestasis; chronic osteomyelitis; comparative effectiveness; diarrhea; dosage schedule comparison; drug safety; drug substitution; drug withdrawal; hematogenous osteomyelitis; human; meta analysis; nausea; osteomyelitis; priority journal; Review; spondylitis; Staphylococcus infection; systematic review; treatment duration; vomiting; adolescent; adult; aged; child; female; infant; male; middle aged; osteomyelitis; preschool child; Staphylococcus aureus; time factor; treatment outcome; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Osteomyelitis; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Treatment Outcome; Young Adult
Publisher
ELSEVIER SCIENCE BV
Type
journal article