Approach to managing infection of diabetes-related foot ulcers

Infection of diabetes-related foot ulcers should always be considered serious; it is often worse than it appears. Specialised multidisciplinary management that includes interventions to promote wound healing is recommended; for details, see Wounds on a high-risk foot. Avoid cytotoxic antiseptics (eg sodium hypochlorite, hydrogen peroxide) because they can impede wound healing.

Do not treat noninfected ulcers with antibiotic therapyCommons, 2021.

Choice of empirical antibiotic therapy for infection of diabetes-related foot ulcers depends on the severity of the infection; see:

• Empirical therapy for mild infection of diabetes-related foot ulcers
• Empirical therapy for moderate infection of diabetes-related foot ulcers
• Empirical therapy for severe infection of diabetes-related foot ulcers.

Urgent early surgical advice should be sought for patients with severe or moderate infection, particularly those with extensive gangrene, necrotising infection, signs suggesting deep infection or abscess, or severe lower limb ischaemiaCommons, 2021.

Antibiotic therapy without surgical debridement or amputation can be successful in systemically well patients with osteoarticular involvement, particularly when the infection is limited to the forefoot (toes and metatarsals)Commons, 2021Senneville, 2023.

More than 50% of patients with a diabetes-related foot ulcer have concurrent peripheral artery diseaseChuter, 2022. Early diagnosis and management of peripheral artery disease is critical to improve wound healing, and reduce the risk of further infection and amputationChuter, 2022; see Peripheral artery disease.