DIABETIC FOOT INFECTIONS - ANTIMICROBIAL THERAPY

Pedal infection in diabetic patients is both a common and potentially disastrous complication that can progress rapidly to irreversible sept ic gangrene necessitating amputation of the foot. The choice of optima l antibiotic therapy depends on an accurate assessment of sepsis sever ity, reliable microbiologic data, and consideration of host factors, s uch as renal and vascular impairment. Empiric broad-spectrum antibioti c regimens are generally preferred because of the polymicrobial nature of most pedal infections. Mild infections may be treated as an outpat ient with oral antibiotics and close clinical review while moderate/se vere (limb-threatening) and severe (life-threatening) infections requi re resection of necrotic tissue, parenteral broad-spectrum antibiotic therapy, and in some cases, lower limb revascularization once sepsis h as been controlled. Pedal osteomyelitis frequently requires prolonged antibiotic therapy or resection of involved bone. In this article, tre atment trials are reviewed and suitable antibiotic regimens commensura te with the severity of infection are proposed.