Patients at low risk of polymicrobial infection and increased risk of MRSA infection

For mild infection of diabetes-related foot ulcers in patients at low risk of polymicrobial infection (see Antibiotic choice for mild infection of diabetes-related foot ulcers) and increased risk of MRSA infection, useSenneville, 2023:

1clindamycin 450 mg orally, 8-hourly; see advice on duration of therapyclindamycinclindamycinclindamycin

OR

1doxycycline 100 mg orally, 12-hourly; see advice on duration of therapy. doxycycline doxycycline doxycycline

Alternatively, trimethoprim+sulfamethoxazole can be used. Although the rate of trimethoprim+sulfamethoxazole resistance is lower than the rate of clindamycin or doxycycline resistance in MRSA isolates, trimethoprim+sulfamethoxazole is associated with an increased risk of acute kidney injury and hyperkalaemia in patients with diabetesAustralian Commission on Safety and Quality in Health Care (ACSQHC), 2023Fraser, 2012. If trimethoprim+sulfamethoxazole is used, measure serum creatinine and potassium concentrations before starting treatment, and repeat within 7 days of starting treatmentRajput, 2020. A suitable regimen is:

trimethoprim+sulfamethoxazole 160+800 mg orally, 12-hourly. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. See advice on duration of therapy. trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole

Modify therapy based on the results of culture and susceptibility testing.