Duration of antibiotic therapy for infection of diabetes-related foot ulcers
For duration of therapy for patients with infection of a diabetes-related foot ulcer, see Suggested duration of antibiotic therapy for infection of diabetes-related foot ulcers that have not had surgical debridement or resection for ulcers that have not had surgical debridement or resection and Suggested duration of antibiotic therapy for infection of diabetes-related foot ulcers following surgical debridement or resection for ulcers that have had surgical debridement or resection.
The duration of antibiotic therapy for infection of diabetes-related foot ulcers depends on:
- infection severity at diagnosis (see Severity classification for infections of diabetes-related foot ulcers)
- presence and location of bone or joint infection (osteomyelitis or septic arthritis) at diagnosis
- whether debridement or resection has been performed and whether it was complete
- presence and severity of residual soft tissue infection following debridement or resection
- likelihood of residual bone or joint infection following debridement or resection.
Patients with bacteraemia may require a longer duration of therapy, depending on the isolated pathogen and complications of infection – seek expert advice.
For patients with infection of a diabetes-related foot ulcer that has not been surgically debrided, continue antibiotic therapy until infection has resolved but not necessarily until the ulcer has healed.
|
Severity of infection [NB1] |
Total duration of therapy [NB2] [NB3] |
|
mild |
10 days |
|
moderate or severe: | |
|
without bone or joint infection |
3 weeks [NB4] |
|
with bone or joint infection of forefoot (toes and metatarsals) |
6 weeks (up to 12 weeks may be required if the infection does not resolve) [NB4] [NB5] |
|
with bone or joint infection of mid- or hindfoot or extensive unresected necrotic tissue |
up to 12 weeks (shorter course if infection has resolved earlier) [NB4] [NB5] |
|
Note:
NB1: To assess the severity of infection, see Severity classification for infections of diabetes-related foot ulcers. NB2: Duration of antibiotic therapy applies to patients without bacteraemia. Patients with bacteraemia may require a longer duration of therapy – seek expert advice. NB3: A residual ulcer may be present at the end of therapy; do not continue antibiotic therapy until the ulcer has healed. NB4: The duration refers to total duration of antibiotic therapy (intravenous + oral). NB5: If infection has not resolved at 12 weeks, seek surgical advice. | |
|
Degree of debridement or resection and severity of residual skin and soft tissue infection [NB1] |
Likelihood of residual bone or joint infection |
Duration of therapy [NB2] [NB3] |
|
complete and no residual infection [NB4] |
none |
2 to 5 days |
|
incomplete and mild residual infection |
low [NB5] |
10 days |
|
incomplete and moderate or severe residual infection |
low [NB5] |
3 weeks |
|
high [NB5] |
6 weeks (shorter course if infection has resolved earlier) | |
|
Note:
NB1: To assess the severity of infection, see Severity classification for infections of diabetes-related foot ulcers. NB2: Duration of antibiotic therapy applies to patients without bacteraemia. Patients with bacteraemia may require a longer duration of therapy – seek expert advice. NB3: The duration refers to total duration of antibiotic therapy (intravenous + oral). NB4: Complete resection of all infected bone can be assumed if the surgical resection extends proximally at least one joint from the affected bone or joint. NB5: If incomplete debridement or resection has been performed, the likelihood of residual bone or joint infection can be assessed by the surgeon, or by histopathological assessment of proximal bone, when available. Culture of proximal bone samples should always be used in conjunction with histopathology, because of a high likelihood of false-positive and false-negative results with the use of culture aloneVoon, 2022. | ||