Patients at increased risk of polymicrobial and MRSA infection

For mild infection of diabetes-related foot ulcers in patients at increased risk of polymicrobial infection (see Antibiotic choice for mild infection of diabetes-related foot ulcers) and increased risk of MRSA infection, a regimen containing trimethoprim+sulfamethoxazole may be an option. However, trimethoprim+sulfamethoxazole is associated with an increased risk of acute kidney injury and hyperkalaemia in patients with diabetesFraser, 2012. If trimethoprim+sulfamethoxazole is used, measure serum creatinine and potassium concentrations before starting treatment, and repeat within7 days of starting treatmentRajput, 2020. A suitable 2-drug regimen is:

For patients who cannot tolerate trimethoprim+sulfamethoxazole, seek expert advice.

Modify therapy based on the results of culture and susceptibility testing.