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Can Adjunctive Rifampin Improve Amputation-Free Survival In Diabetic Foot Osteomyelitis?

Important initial work from Wilson and coworkers suggests that adjunctive rifampin may lead to more amputation-free survival in U.S. veterans with diabetic foot osteomyelitis.1 While more work is necessary to confirm or refute this data, it bears another look for all of us.

This cohort study looked at 6,174 veterans with diabetic foot osteomyelitis. Those treated with rifampin showed an end point of amputation-free survival of 26.9 percent while those not treated with rifampin exhibited a 37 percent rate of these outcomes. Those treated with rifampin began taking the drug within six weeks of diagnosis and had at least 14 days of therapy within 90 days of diagnosis.

It has long been known that rifampin has a synergistic effect with a variety of antimicrobials for treatment of certain infections although the mechanism of action is not entirely clear. 

The study authors noted that many of the patients studied were younger and had less comorbidities. However, even after controlling for this, there was a positive physiologic response favoring the patients treated with rifampin. 

Readers can take several points away from this study. Rifampin is a drug to watch as far as emerging evidence for diabetic foot osteomyelitis goes. Further questioning could assess when to initiate therapy, under what circumstances, the duration of therapy and what other medical or surgical interventions could one administer in combination with rifampin.

Dr. Armstrong is a Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA). 

Editor’s Note: This blog originally appeared at: . It is adapted with permission from the author.


  1. Wilson BM, Bessesen MT, Doros G, et al. Adjunctive rifampin therapy for diabetic foot osteomyelitis in the Veterans Health Administration. JAMA Netw Open. 2019;2(11):e1916003. 
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