6 or 12 weeks of antibiotic therapy for untreated osteomyelitis in the diabetic foot without surgery?

Enjoy this provocative work from our colleagues Eric Senneville and Team:
Six- Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study.
Diabetes Care. 2014 Nov 20. pii: DC_141514. [Epub ahead of print]
Tone A1, Nguyen S1, Devemy F2, Topolinski H3, Valette M1, Cazaubiel M4, Fayard A5, Beltrand E6, Lemaire C3, Senneville E7.
RESEARCH DESIGN AND METHODS: This was a prospective randomized trial comparing 6- versus 12- week duration of antibiotic treatment. Remission of osteomyelitis during the monitoring period was defined as complete and persistent (>4 weeks) healing of the wound (if present initially), absence of recurrent infection at the initial site or that of adjacent rays, and no need for surgical bone resection or amputation at the end of a follow-up period of at least 12 months after completion of antibiotic treatment.
RESULTS: Forty patients followed at five French general hospitals were randomized between January 2007 and January 2009, with 20 treated for 6 weeks and 20 treated for 12 weeks with antibiotics. The two groups were comparable for all variables recorded at inclusion in the study. Remission was obtained in 26 (65%) patients, with no significant differences between patients treated for 6 versus 12 weeks (12/20 vs. 14/20, respectively; P = 0.50). We did not identify any significant parameters associated with patient outcome. Fewer patients treated for 6 weeks experienced gastrointestinal adverse events related to antimicrobial therapy compared with patients treated for 12 weeks (respectively, 15 vs. 45%; P = 0.04).
CONCLUSIONS: In conclusion, the present multicenter prospective randomized study provides data suggesting that 6-week duration of antibiotic therapy may be sufficient in patients with DFO for whom nonsurgical treatment is considered.

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