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Patients with diabetic foot infections and associated osteomyelitis can be treated medically or surgically, but randomized trials to guide this decision are lacking. In this study from Spain, 52 diabetic patients with neuropathic foot ulcers complicated by osteomyelitis were randomized to receive either a 90-day course of antibiotics or “conservative surgery” (i.e., removal of infected bone without performing amputation) followed by 10 days of antibiotic therapy. In all patients, antibiotic therapy was guided by deep soft-tissue cultures. Patients with severe soft-tissue infections, substantial peripheral arterial disease, or exposed bone at the bottom of ulcers were excluded. Forty-six patients completed the study.
Primary healing (i.e., co…