Patients at low risk of MRSA infection

For patients with moderate infection of a diabetes-related foot ulcer who can be managed with oral therapy and are at low risk of MRSA infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), use:

1amoxicillin+clavulanate 875+125 mg orally, 8-hourly1. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate oral dosage adjustment. See advice on duration of therapy amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

OR as a 2-drug regimen

1cefalexin 1 g orally, 6-hourly2. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment. See advice on duration of therapy cefalexin cefalexin cefalexin

PLUS

metronidazole 400 mg orally, 12-hourly. See advice on duration of therapy. metronidazole metronidazole metronidazole

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin3, the cefalexin-based regimen above can be used.

For patients who have had a severe (immediate or delayed)4 hypersensitivity reaction to a penicillin, use the regimen for patients at increased risk of MRSA infection.

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

1 This dosage of amoxicillin+clavulanate is recommended for moderate infection of diabetes-related foot ulcers to ensure adequate drug exposure, particularly if deeper tissues are involved (eg bones, joints or tendons)Cortes-Penfield, 2023Senneville, 2023.Return
2 This dosage of cefalexin is recommended for moderate infection of diabetes-related foot ulcers to ensure adequate drug exposure, particularly if deeper tissues are involved (eg bones, joints or tendons)Cortes-Penfield, 2023Senneville, 2023.Return
3 Cefalexin may be used in patients who have had a nonsevere (immediate or delayed) reaction to amoxicillin or ampicillin. However, because cross-reactivity between these drugs is possible, consideration should be given to the extent of the reaction, patient acceptability, and the suitability of non–beta-lactam options.Return
4 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return