Introduction: Osteomyelitis is a severe complication of diabetes-related foot ulcers (DFUs) often managed with antibiotic therapy and surgical resection of the infected bone. Areas of research: While intravenous (IV) antibiotics have been the traditional approach for bone and joint infections in general, randomized clinical trials have shown that, overall, oral antibiotics are non-inferior to IV antibiotics. While comparisons between oral antibiotics are generally lacking, the data suggest that oral antibiotics with high bioavailability and bone penetration ratios should be prioritized for osteomyelitis treatment, including diabetic foot osteomyelitis (DFO). Oral regimens reduce hospital stays, avert catheter-related complications, and decrease treatment costs while improving patient satisfaction and quality of life. Despite these advantages, IV antibiotics remain widely used, partly due to clinical tradition and concerns about oral absorption in individuals with diabetes. Current guidelines recommend transitioning to oral therapy once systemic signs improve, but robust data supporting oral-only regimens for DFO treated non-surgically remain limited. Conclusions: Oral antibiotics represent a safe and effective alternative to IV therapy for many patients with DFO, particularly when high-bioavailability agents are used. Further well-designed studies are needed to validate their efficacy in non-surgical DFO management and inform clinical guidelines.

Background: Formulating effective regimens to treat children with drug-resistant tuberculosis (TB) remains a great challenge. We aimed to compare treatment outcomes among children treated with regimens containing newer second-line anti-TB drugs to those treated with previously used regimens. Methods: We conducted a retrospective cohort study of individuals ≤18 years old treated for rifampicin-resistantTB in the country of Georgia from 2009 to 2023. We defined “new and repurposed second-line drugs (SLDs)” as regimens that contained bedaquiline, delamanid and/or linezolid; otherwise categorized as “traditional SLDs.” We defined poor end-of-treatment outcomes if participants were lost to follow-up, experienced treatment failure or died during treatment. We defined poor long-term outcomes as TB recurrence and/or all-cause mortality after TB treatment completion. We reported relative risks and 95% confidence intervals (CIs) estimated with multivariable log-binomial regression models. Results: We included 158 children and adolescents; 51 (32%) received new and repurposed SLDs and 107 (68%) received traditional SLDs. Poor end-of-treatment outcome was much less common among those who received new and repurposed SLDs compared with those who received traditional SLDs [1 (2%) vs. 18 (18%); adjusted risk ratio, 0.11 (95% CI, 0.01–0.50)]. Poor long-term outcomes occurred among 7 (4%) participants, including 4 [3% (95% CI, 0.8–6.0)] who had recurrent TB (2 received traditional SLDs and 2 received new and repurposed SLDs) and 3 [2% (95% CI, 0.5–5.1)] who died after TB treatment completion (all received traditional SLDs). Conclusions: Children and adolescents treated for rifampicin-resistant TB with new and repurposed drugs had much better treatment outcomes than those treated with traditional SLDs.