Rationales Determining an Antibiotic Treatment Versus a Direct Surgical Resection in Various Strata of Diabetic Foot Osteomyelitis

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Abstract
Background/Objectives: When presented with chronic osteomyelitis of the diabetic foot (DFO), clinicians, patients and their families have two options: rational use of antibiotics or direct surgery. Methods: We conducted a narrative, scientific literature review and administered questionnaires to DFO experts to investigate the factors indicating conservative, antibiotic-based therapy vs. direct surgery to treat DFO. Results: If large necrotic areas and destructed bone are present, providers may opt for a direct surgical amputation or internal resection of the infected bone (conservative surgery). Alternatively, they can choose conservative (targeted) antibiotic therapy lasting several weeks, with minimal soft tissue debridement, off-loading and iterative professional wound care. Conclusions: It is difficult to decide between the two treatments. The rationale for choosing either approach is complex, involving many clinical aspects to consider, which we discuss in this article.

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