Optimal Duration of Antibiotic Therapy for Primary Osteomyelitis Discitis: A Systematic Review and Network Meta-Analysis

Study design: Systematic Review and Network-Meta-analysis.

Purpose: This study aimed to systematically review the literature on management of primary osteomyelitis discitis and perform a network meta-analysis comparing the efficacy of different antibiotic treatment durations.

Background: Primary osteomyelitis discitis is a challenging condition with varying management strategies.

Methods: A comprehensive literature search was conducted. Studies reporting outcomes for treatment of primary osteomyelitis discitis were included. A random-effects network meta-analysis was performed comparing antibiotic treatment durations of <4 weeks, 4-8 weeks, 8-12 weeks, and 12-16 weeks. The surface under the cumulative ranking curve (SUCRA) was used to rank treatment effectiveness.

Results: Sixty-three articles with 4,233 patients were included. Staphylococcus aureus was the most common causative agent (57.6%). The 4-8 week antibiotic duration ranked highest across fixed-effect and random-effects models (SUCRA 0.8207 and 0.8343). The 12-16 week duration ranked highest in the fixed-effect model (SUCRA 0.8460) but dropped substantially in the random-effects model (SUCRA 0.3067). The <4 week duration showed mixed results. The 8-12 week duration consistently ranked lowest. No statistically significant differences were found between durations for symptomatic relief.

Conclusion: Antibiotic therapy for 4-8 weeks may provide the optimal balance of efficacy and treatment duration for most patients with primary osteomyelitis discitis. However, treatment should be individualized based on clinical response. Further prospective studies are needed to clarify optimal management strategies for this complex condition.