Be Familiar With Meds for Diabetes-Related Foot Infections

You’ll see more emphasis on treating foot infections in patients with diabetes...due to updated treatment guidelines.

Diabetes cases continue to grow...and foot infections are the most common complication leading to hospitalization and amputation.

Familiarize yourself with common antibiotic treatments.

Mild infections have local swelling with a small amount of redness around the wound. Expect to dispense oral agents for these patients...usually cephalexin or dicloxacillin.

But for patients who’ve taken antibiotics within the past month, an agent with broader coverage is needed, such as amoxicillin/clavulanate.

Anticipate also dispensing doxycycline or TMP/SMX in patients at risk for resistant “staph”...or MRSA.

Moderate infections are seen in patients with deeper wounds and a larger area of redness. But these patients don’t have systemic signs of infection (fever, rapid heart rate, etc).

Expect to dispense amoxicillin/clavulanate in most cases, especially if the wound has a foul odor or dying tissue.

But some high-risk patients will need IV antibiotics instead, such as those who also have peripheral artery disease.

Severe infections include any patient with at least 2 systemic signs of infection...or not responding to oral therapy.

These patients need IV antibiotics that cover a wide range of organisms. Expedite IV agents such as ampicillin/sulbactam...or IV combos such as ceftriaxone plus metronidazole.

If patients also have risk factors for MRSA, expect orders to also dispense IV vancomycin.

For treatment duration and when to switch to po, see our resource, Skin and Soft Tissue Infections.

If you get questions about patients with penicillin allergies, alert your pharmacist so they can investigate whether it’s a true allergy. And share our resource, Managing Beta-Lactam Allergies.

Key References

  • Senneville É, Albalawi Z, van Asten SA, et al. IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023). Clin Infect Dis. 2023 Oct 2:ciad527. doi: 10.1093/cid/ciad527.
  • Peters EJG, Albalawi Z, van Asten SA, et al. Interventions in the management of diabetes-related foot infections: A systematic review. Diabetes Metab Res Rev. 2024 Mar;40(3):e3730.
  • Polk C, Sampson MM, Roshdy D, Davidson LE. Skin and Soft Tissue Infections in Patients with Diabetes Mellitus. Infect Dis Clin North Am. 2021 Mar;35(1):183-197.
Hospital Pharmacy Technician's Letter. June 2024, No. 400622

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