Use of Oral Antibiotics for Diabetic Foot Osteomyelitis: A Systematic Review
Bibliographic record
Abstract
The optimal treatment modality for diabetic foot osteomyelitis (DFO) remains unclear. The current guidelines from Diabetes Canada recommend the use of oral antibiotics and/or intravenous antibiotics with no preferred agent or route of administration. This report aimed to evaluate the current evidence surrounding oral antibiotic therapy for DFO. Embase and MEDLINE databases were searched for original articles written in English that reported efficacy and safety data on oral antibiotic use for this indication. Twenty-six unique studies were included, encompassing 972 patients treated with oral antibiotics. The mean age was 64.6 years (range: 30 to 90 y). When used as monotherapy, the complete resolution and partial resolution rate for oral antibiotic therapy were 75.2% (539/717) and 3.2% (23/717), respectively. When used as a step-down therapy after intravenous antibiotics, the complete and partial resolution rate for oral antibiotics were 56.5% (155/255) and 20.4% (52/255), respectively. No resolution of DFO resulting in refractory infection or amputation was observed in 155 (21.6%) cases of oral antibiotics monotherapy and 59 (23.1%) of step-down therapy. Recurrence rates for oral antibiotics monotherapy and step-down therapy were 5.4% (39/717) and 3.9% (10/255), respectively. Oral antibiotic therapy demonstrates favorable outcomes in DFO comparable to intravenous treatment. Oral antibiotic therapy may be especially useful in low-resource settings where hospital beds are limited and in situations where patients require ambulation. Nonetheless, patients should be counselled on the vital importance of adherence, and resource stewardship should be practiced by health care providers to avoid antibiotic resistance. GENERAL PURPOSE: To present a systematic review article evaluating the utility of oral antibiotics for the treatment of diabetic foot osteomyelitis. JOURNAL/aswca/04.03/00129334-202511000-00004/figure1/v/2025-11-11T122732Z/r/image-jpeg TARGET AUDIENCE: This continuing education activity is intended for physicians; physician assistants; nurse practitioners; podiatrists/other foot specialists; and registered nurses with an interest in skin, wound, and diabetic foot care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, the participant should be better able to: Summarize the evidence the authors considered when evaluating the utility of oral antibiotics for diabetic foot osteomyelitis.Select the characteristics of the participants and settings in which oral antibiotic therapy was utilized.Identify the results of the authors' study assessing the use of oral antibiotics.Discuss potential situations in which oral antibiotic therapy may provide favorable outcomes as monotherapy or in conjunction with intravenous antibiotics for diabetic foot osteomyelitis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.004 |
| Bibliometrics | 0.006 | 0.009 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".