Antibiotics diabetic foot infection

The pathogenesis of diabetic foot infection stems from three key factors neuropathy, angiopathy, and immunopathy. Aerobic gram-positive cocci, such as S. aureus and P-hemolytic streptococci, are the predominant pathogens in acutely infected diabetic foot ulcers. However, chronically infected wounds are subject to polymicrobial infection and require treatment with broad-spectrum antibiotics. 

The severity of a patient s infection, based on the PEDIS scale, guides the selection of empirical antimicrobial therapy. While most patients with grade 2 diabetic foot infections can be treated as outpatients with oral antimicrobial agents, all grade 4 and many grade 3 infections require hospitalization, stabilization of the patient, and broad-spectrum IV antibiotic therapy.31... 

Grayson ML, Gibbons GW, Habershaw GM, et al. Use of ampiciflin-sulbactam versus imipenem-cilastatin in the treatment of Umb-threatening foot infections in diabetic patients. CUn Infect Dis 1994 18 683-693. Lipsky BA, Baker PD, Landon GC, et al. Antibiotic therapy for diabetic foot infections Comparison of two parenteral-to-oral regimens. Qin Infect Dis 1997 24 643-648. 

Studies have shown that the pathogens responsible for diabetic foot infections are Staphylococcus aureus and beta haemolytic streptococci which respond to narrow spectmm antibiotics such as Flucloxacillin and cefalexin. However, progression in severity of infection will result in the emergence of bacteria such as Enterobacterium, Pseudomonas and obligate anaerobes, requiring a broader therapeutic target range. 

Cunha BA. Antibiotic selection for diabetic foot infections a review. J. Foot Ankle Surg. 2000 39 253-257. 

Armstrong DG, Findlow AH, Cybil SC, Boulton AJM. Absorbable antibiotic-impregnated calcium sulphate pellets in the management of diabetic foot infections. Diabet. Med. 2001 18 937-948. 

Common Sites of Invasion Anaerobes colonize the mouth, gastrointestinal tract and skin of all persons. Infections develop when anaerobes penetrate poorly oxygenated tissues (e.g., the diabetic foot) or tissues that are normally sterile (e.g., peritoneum). When broad spectrum antibiotics diminish normal bowel flora, C. difficile proliferates and releases a toxin that causes pseudomembranous colitis. 

The superficial mycotic infections occur on the surface of, or just below, the skin or nails. Superficial infections include tinea pedis (athlete s foot), tinea cruris (jock itch), tinea corporis (ringworm), onychomycosis (nail fungus), and yeast infections, such as those caused by Candida albicans. Yeast infections or those caused by C. albicans affect women in the vulvovaginal area and can be difficult to control. Women who are at increased risk for vulvovaginal yeast infections are those who have diabetes, are pregnant, or are taking oral contraceptives, antibiotics, or corticosteroids. 

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