The establishment of only two Clear Recommendations highlights the need for additional high-quality studies of osteomyelitis. In particular, studies are needed regarding new approaches to diagnostics; to determine the potential benefit or harm of adding anti-anaerobic antimicrobial therapy for DFO; to elucidate the comparative effectiveness of various antimicrobial options; to determine if adjunctive rifampin therapy has benefit; to identify which patients are more likely to relapse after completion of therapy; to further clarify antibiotic durations of therapy; to define the role and optimal methodologies of surgical management; and to define the role if any of non-antimicrobial adjunctive strategies (e.g., hyperbaric oxygen therapy). We would also like to incorporate authors from LMIC countries in future revisions to ensure the WikiGuidelines are broadly applicable to these settings.
WikiGuidelines represent a novel approach to guideline construction, clearly delineating evidenced-based recommendations from opinions based on lower quality data. Resulting changes in management of pyogenic osteomyelitis include recognizing the low value and high burden that plain X-rays incur if routinely ordered for all patients, reducing the routine ordering of low value, low accuracy blood biomarkers, increasing adoption of oral therapy, and limiting the duration of therapy to the shortest necessary for optimizing cure.
These guidelines are based on published data available as of March 1, 2022. Clinicians who believe other evidence should be considered may contact any of the authors to initiate possible revisions to the guidelines, which the authors intend to complete in close to real time.
WikiGuidelines participants understand that no clinical trial can extrapolate to all possible patient care scenarios. Thus, we expect that these guidelines should not establish medicolegal standards of care or replace clinician judgment for individual patients.