Would you treat sacral osteomyelitis with a prolonged 6-week course of antibiotics in a patient who has undergone surgical debridement and placement of a negative pressure wound therapy device, but for whom flap coverage is not planned?

The decision to use prolonged IV antibiotics depends on many factors beyond the infection itself, including the depth and size of the wound, comorbidities, social support, and the patient’s willingness and ability to participate in wound care.

I have seen ulcers heal without flap coverage, particula...

I would consider shortening the duration of intravenous (IV) antibiotic treatment with earlier transition to oral antibiotics if there was a bone biopsy that was negative for residual osteomyelitis, or if, in discussion with the surgeon, they felt very confident in having removed the area of infecti...

I would not recommend completing a full 6-week course if there is no plan for definitive wound closure or flap coverage.

The best evidence I’m aware of for this situation is the systematic review by Wong et al., PMID 29986022, looking specifically at osteomyelitis associated with stage IV sacral pre...