Modification of intravenous therapy for moderate infection of diabetes-related foot ulcers

Modify intravenous antibiotic therapy for moderate infection of diabetes-related foot ulcers based on the results of culture and susceptibility testing. Switch to oral therapy after significant clinical improvement – see Guidance for intravenous to oral switch. Choice of oral therapy should be based on the results of culture and susceptibility testing.

If the results of culture and susceptibility testing are not available, use the following recommendations for intravenous to oral switch:

for patients at increased risk of MRSA infection, trimethoprim+sulfamethoxazole PLUS metronidazole may be an option
for patients without penicillin hypersensitivity, use amoxicillin+clavulanate or a combination of cefalexin PLUS metronidazole
for patients with nonsevere (immediate or delayed) penicillin hypersensitivity, or severe immediate¹ penicillin hypersensitivity who tolerated cefazolin, use cefalexin PLUS metronidazole unless the patient has had a severe immediate¹ hypersensitivity reaction to amoxicillin or ampicillin
for patients with severe immediate¹ hypersensitivity reaction to amoxicillin or ampicillin or severe delayed² hypersensitivity to any penicillin, trimethoprim+sulfamethoxazole PLUS metronidazole may be an option.

If prolonged intravenous antibiotic therapy is required in patients who are clinically stable, consider intravenous ambulatory antimicrobial therapy.

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

² 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