Diabetic foot infection
- Micro-organism
Staphylococcus aureus, anaerobes
- Duration
Seek Advice
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
First Line
IV Flucloxacillin5 2g 6 hourly
+ IV Metronidazole 500mg 8 hourly
Penicillin Allergy
IV Clindamycin 600mg 6 hourly
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:
- Check interactions in the BNF. Caution may prolong QT interval.
- Avoid Doxycycline and Co-trimoxazole if pregnant or breast feeding
- Gentamicin/Vancomycin refer to online calculators
- ALERT antibiotic needs ALERT form
- Monitor sodium
- See CURB65 definition
- Reference: The Renal Drug Handbook 4th Edition, 2014