1
Are diabetic foot-ulcers infected?
- Half are NOT infected
- No good date supporting use of antibiotic will speed up ulcer healing or reduce risk of infection
- But recommend antibiotics when warmth, redness, drainage
2
Treatment for mild superficial inflammation?
- Gram-positive covering like cephalexin or dicloxacillin
- For patients who's taken antibiotics within past month, consider gram-negatives such as amoxil/ clavunate
- Add MRSA coverage like Doxycyline or TMP/ SMX for history of MRSA or known colonization
- Don't empirically cover Pseudomonas unless risk factors such as recent positive cultures or frequent foot exposure to water (lake, pool)
3
Treatment for severe inflammation (deeper wounds with erythema 2 cm from wound margin WITHOUT systemic signs, like fever, tachycardia)?
- Amoxil/ Clavunate in most cases, especially suspect anaerobes such as wound with foul odor or necrosis
- Consider IV for those who can't tolerate oral/ not adherence to oral or those with peripheral artery disease
- Gram positive + negative + anaerobes covering: IV piperacillin/ Tazobactam
- Add IV Vancomycin for MRSA risk