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• W4233280558 abstract "Osteomyelitis of the jaw (OMJ) is unlike osteomyelitis of long bone. It presents unique challenges to treatment due to odontogenic pathways of infection, polymicrobial nature, and need to preserve facial form and function. The majority of osteomyelitis research comes from orthopedic literature. Thus, there is limited guidance for antibiotic administration in OMJ when treated with surgical management1. Current recommendations suggest 6 weeks of intravenous (IV) antibiotics are necessary for resolution of infection2. However, there are numerous complications associated with IV therapy. Recent orthopedic literature has shown oral (PO) is noninferior to IV antibiotic therapy for complex orthopedic infection. The purpose of this study was to review cases of OMJ treated with surgery and adjunctive antibiotics and determine whether antibiotic route (PO versus IV) and/or length of administration impacted resolution of infection. The investigators designed a retrospective cohort study and enrolled a sample of patients treated at Harborview Medical Center (HMC) from January 1st 2009 to December 31st 2019. (STUDY00007337). The primary predictor variable was antibiotic administration route: oral (PO) only, intravenous (IV) only, IV transitioned to oral (IV+PO), or none. The secondary predictor was duration of antibiotic therapy (≤6 weeks or >6 weeks). The primary outcome variable was resolution of infection, deemed as clinical and radiographic resolution. The secondary outcome variable was number of operative interventions to resolution of infection. Statistical analysis was performed using IBM SPSS 27.0 (SPSS, Inc, Chicago, IL). Descriptive, bivariate, and multiple linear regression statistics were computed, with statistical significance set at p < 0.05. Sixty-seven subjects met the inclusion criteria (38 male), mean age 51 years (18-88). Forty-nine (73%) were treated with PO antibiotics only, 12 (18%) with IV+PO, 3 (4%) with IV only, and 3 (4%) received none. Both PO and IV antibiotics were significantly associated with clinical resolution (p=0.022, 0.005, respectively), compared to debridement alone. However, antibiotic duration of ≤6 weeks compared to >6 weeks was not significant. The majority (84% [41 out of 49]) of PO subjects achieved resolution with one surgery. Eight of 49 (16%) required additional surgeries with a mean of 1.27 (1-4). Fifteen (22%) subjects received IV antibiotics, including subjects who were in the IV only and IV+PO categories. Three of 15 (20%) were IV only, and 12 of 15 (80%) were IV+PO – meaning they were discharged with variable lengths of IV antibiotics and transitioned to PO. Seven of 15 (46%) had clinical resolution after one surgery, while 8 (54%) required additional procedures with a mean of 1.87 (1-5). Identified sources of OMJ were odontogenic (59%), trauma (31%), or dental implant-associated (13%). In the multivariate logistic regression, PO antibiotics were positively associated with clinical outcome (p=0.025, OR=5.05). Regardless of the length of antibiotic therapy, PO subjects were approximately 5 times more likely have clinical resolution without additional surgery. Penicillin allergy (p=0.049, OR=0.223) and diabetes (p=0.008, OR=0.104) were adversely associated with clinical resolution. OMJ can be successfully treated with PO antibiotics and appropriate surgery. IV therapy did not offer an advantage over PO medication in our cohort and is known to be associated with increased complications and cost. While further studies with larger cohorts are recommended, reflexively prescribing 6 weeks of IV antibiotics as preliminary therapy seems antiquated. Clinicians should consider oral penicillins as first line whenever possible." @default.
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• W4233280558 date "2021-10-01" @default.
• W4233280558 modified "2023-10-14" @default.
• W4233280558 title "Are Oral Antibiotics an Effective Alternative to Intravenous Antibiotics in Treatment of Osteomyelitis of the Jaw?" @default.
• W4233280558 doi "https://doi.org/10.1016/j.joms.2021.08.020" @default.
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