Shorter treatments for vertebral osteomyelitis

Abstract

Vertebral osteomyelitis is a particular infection of bone and surrounding tissues that tends to affect elderly patients more than younger patients. It has been increasing in incidence in the past few years, in line with the general ageing of the population and the resulting increase in chronic diseases, and with the greater availability of MRI. 1 Zimmerli W Vertebral osteomyelitis. N Engl J Med. 2010; 362: 1022-1029 Crossref PubMed Scopus (365) Google Scholar , 2 Lew DP Waldvogel FA Osteomyelitis. Lancet. 2004; 364: 369-379 Summary Full Text Full Text PDF PubMed Scopus (1268) Google Scholar , 3 Mylona E Samarkos M Kakalou E Fanourgiakis P Skoutelis A Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009; 39: 10-17 Summary Full Text Full Text PDF PubMed Scopus (358) Google Scholar Although related mortality is low, the frequency of sequelae and associated morbidity is a concern in this group of patients. Overall, a high proportion of patients with vertebral osteomyelitis are cured, usually after receiving long-term antimicrobial treatment and no concomitant surgery, by contrast with other types of osteomyelitis. 1 Zimmerli W Vertebral osteomyelitis. N Engl J Med. 2010; 362: 1022-1029 Crossref PubMed Scopus (365) Google Scholar , 2 Lew DP Waldvogel FA Osteomyelitis. Lancet. 2004; 364: 369-379 Summary Full Text Full Text PDF PubMed Scopus (1268) Google Scholar , 3 Mylona E Samarkos M Kakalou E Fanourgiakis P Skoutelis A Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009; 39: 10-17 Summary Full Text Full Text PDF PubMed Scopus (358) Google Scholar However, current recommendations on the most appropriate antibiotics, route of administration, and length of therapy are mainly based on expert opinion and extrapolation from observational studies, 1 Zimmerli W Vertebral osteomyelitis. N Engl J Med. 2010; 362: 1022-1029 Crossref PubMed Scopus (365) Google Scholar , 4 Stengel D Bauwens K Sehouli J Ekkernkamp S Porzsolt F Systematic review and meta-analysis of antibiotic therapy for bone and joint infections. Lancet Infect Dis. 2001; 1: 175-188 Summary Full Text Full Text PDF PubMed Scopus (238) Google Scholar and randomised controlled trials are scarce. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial6 weeks of antibiotic treatment is not inferior to 12 weeks of antibiotic treatment with respect to the proportion of patients with pyogenic vertebral osteomyelitis cured at 1 year, which suggests that the standard antibiotic treatment duration for patients with this disease could be reduced to 6 weeks. Full-Text PDF