Diabetic foot infection

Micro-organism

Staphylococcus aureus, anaerobes

Duration

Seek Advice

Severe infection

First Line:

IV Flucloxacillin5 2g 6 hourly

+IV Clindamycin 600mg 6 hourly

+ IV Gentamicin3

 

Penicillin Allergy or MRSA Suspected

IV Vancomycin3

+ IV Clindamycin 600mg 6 hourly

 + IV Gentamicin3

 

Moderate Infection

First Line

IV Flucloxacillin5 2g 6 hourly

+ IV Metronidazole 500mg 8 hourly

 

Penicillin Allergy 

IV Clindamycin 600mg 6 hourly

Mild Infection

First Line

ORAL Flucloxacillin 1g 6 hourly

 

Penicillin Allergy

ORAL Clindamycin 450mg 6 hourly

Notes

Ulcers always colonised. Antibiotics do not improve healing unless active infection.

Notify diabetologist at first opportunity. Send specimen for culture and review previous microbiology. Sampling for cultures requires cleaning then vigorous curettage and aspiration.

 

Review antibiotics after culture results.

 

Doses may need to be adjusted in renal impairment. Always check BNF for interactions. Seek advice if patient pregnant

Drug specific interactions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid Doxycycline and Co-trimoxazole if pregnant or breast feeding
  3. Gentamicin/Vancomycin refer to online calculators
  4. ALERT antibiotic needs ALERT form
  5. Monitor sodium
  6. See CURB65 definition
  7. Reference: The Renal Drug Handbook 4th Edition, 2014