Diabetic Foot Infections - Moderate

Antibiotic Naive

Flucloxacillin 1g PO qds (+ Metronidazole 400mg PO tds if anaerobes suspected)

Antibiotic Naive - Penicillin Allergy

Clindamycin 450mg PO qds (Has anaerobic cover)

Non-Antibiotic Naive

Co-amoxiclav PO 625mg tds

or

Clindamycin PO 450mg qds (unless had before for same infection - d/w medical microbiology)

If requiring admission due to severity:

Co-amoxiclav 1.2g IV 8hrly

(add Vancomycin IV if MRSA suspected)

Non - Antibiotic Naive - Penicillin Allergy

Ciprofloxacin 500mg PO bd AND Vancomycin IV as per protocol (for gram+ve cover) AND Metronidazole 500mg IV 8hrly

OR

Gentamicin IV as per protocol  AND Vancomycin IV as per protocol (for gram +ve cover) AND Metronidazole 500mg IV tds (d/w microbiology re Gentamicin course length)

Oral switch

Review microbiology results and prescribe accordingly

For culture negative infections

Co-amoxiclav PO 625mg tds or

Ciprofloxacin 500mg PO bd + Clindamycin 300-450mg PO qds

MRSA

Vancomycin IV as per protocol

Osteomyelitis

Add second agent to Vancomycin IV after review of sensitivities and discussion with microbiology

Oral switch

Review of sensitivities and discussion with microbiology

Notes

Please note this part of policy is under review

SYMPTOMS

  • Lymphatic streaking, deep tissue involving subcutaneous tissue, tendon, fascia, bone or abscess or
  • Cellulitis >2cm and
  • No evidence of systemic infection

Treatment Duration

Treat for 14 days, review and continue or discontinue as appropriate

Follow guidance in IV to oral switch policy

If osteomyelitis present, discuss with mirobiologist and treat for at least 4-6 weeks