To the Editor:
Henke and coworkers studied osteomyelitis of the foot and toes using a large national database of hospitalized patients along with their own hospital information. They concluded that preadmission use of antibiotics may decrease the chance of wound healing, and is significantly associated with limb loss. Their report is based only on hospital data, which would cause a substantial bias, if we assume that some patients seeking treatment of cellulitis of the foot were successfully treated on an ambulatory basis with antibiotics and thus avoided hospitalization and/or amputation. Selection bias, inherent in the study design, could explain a good part of the adverse risk associated with prehospital antibiotic use.
Albert B. Lowenfels, MD
New York Medical College Valhalla, New York
E-mail: lowenfel@nymc.edu