Evidence-based antibiotic therapy of diabetic foot infections


  • Benjamin A Lipsky

    Corresponding author
    1. Department of Medicine, University of Washington School of Medicine and Medical Service, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108-1597 USA
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*Corresponding author. Tel.: +1 (206) 762 1010/1640; Fax. +1 (206) 764-2849, E-mail address: balipsky@u.washington.edu


In addition to proper cleansing, debridement and local wound care, foot infections in diabetic patients require carefully selected antibiotic therapy. Serious infections necessitate hospitalization for initial parenteral broad-spectrum antibiotic therapy. Appropriately selected patients with mild infections can be treated as outpatients with oral (or even topical) therapy. Initial antibiotic selection is usually empirical, but definitive therapy may be modified based on culture results and the clinical response. Therapy should nearly always be active against staphylococci and streptococci, with broader-spectrum agents indicated if Gram-negative or anaerobic organisms are likely. In infected foot tissues levels of most antibiotics, except fluoroquinolones, are often subtherapeutic. The duration of therapy ranges from a week (for mild soft tissue infections) to over 6 weeks (for osteomyelitis). Recent antibiotic trials have shown that several intravenously or orally administered agents are effective in treating these infections, with no one agent or combination emerging as optimal. Suggested regimens based on the severity of infection are provided.