Empirical therapy for severe infection of diabetes-related foot ulcers
For patients with severe infection of a diabetes-related foot ulcer who have sepsis or septic shock, start antibiotic therapy within 1 hour of presentation to medical care or, for ward-based patients, development of sepsis or septic shock. Antibiotics should be administered immediately after blood samples are taken for culture. Collect deep tissue samples as soon as possible; however, do not delay antibiotic administration or surgery to do so. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock.
Urgent early surgical advice is recommended for patients with severe infection of a diabetes-related foot ulcer, including patients with extensive gangrene, necrotising infection, signs suggesting deep infection or abscess, or severe lower limb ischaemiaCommons, 2021. For additional management considerations, see Approach to managing infection of diabetes-related foot ulcers.
For patients with severe infection of a diabetes-related foot ulcer who are at low risk of methicillin-resistant Staphylococcus aureus (MRSA) infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), use:
For patients with hypersensitivity to penicillins who are at low risk of MRSA infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), as a 2-drug regimen, use:
ciprofloxacin 400 mg intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see ciprofloxacin intravenous dosage adjustment. See advice on duration of therapy ciprofloxacin ciprofloxacin ciprofloxacin
PLUS
clindamycin 600 mg intravenously, 8-hourly. See advice on duration of therapy4. clindamycin clindamycin clindamycin
For patients who have severe limb- or life-threatening infection, or those at increased risk of MRSA infection, add vancomycin to the above regimens. Use:
vancomycin intravenously; see Vancomycin dosing in adults for initial dosing. Loading doses are recommended for critically ill adults. See advice on duration of therapy. vancomycin vancomycin vancomycin
Modify therapy based on the results of culture and susceptibility testing. If culture and susceptibility results are not available by 72 hours and the patient is clinically improving, use a regimen for moderate infection of diabetes-related foot ulcers for ongoing therapy. It is not necessary to continue treatment active against Pseudomonas aeruginosa or MRSA if they are not identified on culture.
If prolonged intravenous antibiotic therapy is required in patients who are clinically stable, consider intravenous ambulatory antimicrobial therapy.