Diabetic foot infection treatment

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. 

Tigecycline is not currently approved for the treatment of diabetic foot infections. 

Lipsky BA, Berendt AR, Deery G, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004 39 885-910. Livesley NJ, Chow AW. Pressure ulcers in elderly individuals. Clin Infect Dis 2002 35 1390-1396. 

Diabetic foot infections are managed with a comprehen- sive treatment approach that includes both proper wound care and antimicrobial therapy. Antimicrobial regimens for diabetic foot infections should include broad-spectrum coverage of staphylococci, streptococci, enteric gram-negative bacilli, and anaerobes. Outpatient therapy with oral antimicrobials should be used whenever possible. 

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. 

Second-generation cephalosporins generally have been displaced by third-generation agents. The oral second-generation cephalosporins can be used to treat respiratory tract infections, although they are inferior to amoxiciUin for treatment of peniciUin-resistant S. pneumoniae pneumonia and otitis media. Cefoxitin and cefotetan both are effective in situations where facultative gramnegative bacteria and anaerobes are involved e.g., intra-abdominal infections, pelvic inflammatory disease, and diabetic foot infection). 

H. influenzae, gonococci, and E. coli. It also is effective in the treatment of acute otitis media in children, sinusitis, animal or human bite wounds, cellulitis, and diabetic foot infections. The addition of clavulanate to ticarcillin (timentin) extends its spectrum to include aerobic gram-negative bacilli, S. aureus, and Bacteroides spp. There is no increased activity against Pseudomonas spp. 

Bridges RM, Deitch EA. Diabetic foot infections. Pathophysiology and treatment. Surg. Clin. North Am. 1994 74 537-545. 

Schaper NC, Dryden M, Kujath P, Nathwani D, Arvis P, Reimnitz P, et al. Efficacy and safety of IV/PO moxifloxacin and IV piperaeflUn/ tazobactam followed by PO amoxiciUin/clavulanic acid in the treatment of diabetic foot infections results of the RELIEF study. Infection 2013 41(l) 175-86. 

Complicated skin and skin structure infections (SSSIs) For the treatment of complicated SSSIs caused by S. aureus (methicillin-susceptible and -resistant strains). Streptococcus pyogenes, or Streptococcus agalactiae. It has not been studied in the treatment of diabetic foot and decubitus ulcers. 

B. Indications and nse Regranex Gel is indicated for the topical treatment of deep diabetic foot and leg ulcers that have an adequate blood supply. Patients with diabetes who develop chronic ulcers of the foot and leg are at higher risk for local and systemic infections and amputation. 

The patient is diagnosed with hyperosmolar non-ketotic (HONK) syndrome secondary to infection of a diabetic foot ulcer and the treatment plan is as follows ... 

LeErock J, Blais E, Schell, et al. Cefoxitin in the treatment of diabetic patients with lower extremity infections. Infect Surg 1983 2 361-374. Hughes C, Johnson C, Bamberger D, et al. Treatment and long-term follow-up of foot infections in patients with diabetes or ischemia A randomized, prospective, double-blind comparison of cefoxitin and cefti-zoxime. CUn Ther 1987 10(suppl A) 36-49. 

West NJ. Systemic antimicrobial treatment of foot infections in diabetic patients. Am J Health Syst Pharm 1995 52 1199-207. 

Eneroth M, Larsson J, Apelqvist J. Deep foot infections in patients with diabetes andfoot ulcer An entity with different characteristics, treatments, and prognosis. J Diabetes Complications 1999 13 254-263. 

Immunologic Two cases of ciprofloxacin-induced hemorrhagic vasculitis have been reported in two patients with diabetes and infected ischemic foot ulcers after treatment with ciprofloxacin plus clindamycin for 4 and 6 days [48" ]. The vasculitis resolved completely 2 weeks after withdrawal in one case, but progressive infection and gangrene necessitated below-knee amputation in the other. 

An infected foot ulcer precedes approximately 60% of lower limb amputations in the diabetic population [13], thus the rapid and appropriate treatment of soft tissue infection is paramount. There is substantial evidence suggesting that people with diabetes are more susceptible to infection due to altered immune-response [14]. Polymorphonuclear neutrophil oxidative burst activity is thought to be reduced in addition to decreased bacterial killing... 

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