Patients at low risk of MRSA infection
For patients with moderate infection of a diabetes-related foot ulcer who require intravenous therapy and are at low risk of MRSA infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), useHand, 2019:
1amoxicillin+clavulanate 2+0.2 g intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate intravenous dosage adjustment. See advice on modification and duration of therapy amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate
OR
1amoxicillin+clavulanate 1+0.2 g intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate intravenous dosage adjustment. See advice on modification and duration of therapy
OR as a 2-drug regimen
1cefazolin 2 g intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefazolin dosage adjustment. See advice on modification and duration of therapy cefazolin cefazolin cefazolin
PLUS
metronidazole 500 mg intravenously, 12-hourly. See advice on modification and duration of therapy. metronidazole metronidazole metronidazole
For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use the cefazolin-based regimen above.
For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin, the cefazolin-based regimen above can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).
For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin in whom cefazolin is not used, or for patients who have had a severe delayed2 hypersensitivity reaction to a penicillin, use intravenous ciprofloxacin plus clindamycin, as for severe infection.