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We appreciate very much the comments on our article (1) from Landman et al. (2). It could be extracted that every patient in whom osteomyelitis is suspected should undergo a bone biopsy, but this is not based on evidence. Based on this thought, the current tendency of treating diabetic foot osteomyelitis exclusively with antibiotics could not be supported. Most studies in which the patients were treated with antibiotics did not have microbiologic and/or histopathologic confirmation of bone infection. The only modern series confirming osteomyelitis by histopathology and microbiology are probably surgical. We could conclude that most patients in whom antibiotics were successful did not in fact have osteomyelitis. …

diabetes care

Response to Comment on Lázaro-Martínez et al. Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial. Diabetes Care 2014;37:789–795