Prevention and treatment of diabetic foot infections

As a pharmacist, you'll see more focus on prevention and treatment of diabetic foot infections. More than half of foot ulcers in diabetes patients develop into diabetic foot infections... Recommend choosing empiric antibiotics based on infection severity and likely pathogens. For mild infections, recommend oral antibiotics that cover strep and S. aureus. Suggest using cephalexin (Ceporex), or clindamycin (Dalacin) if methicillin-resistant Staph aureus (MRSA) isn't likely, and doxycycline (Vibramycin) or TMP/SMX (Septrin) if it is.

     Don't be surprised to see combination therapy if physicians want to cover strep and MRSA, doxycycline and TMP/SMX don't always cover strep. Explain that MRSA is more likely if the patient has been recently hospitalized or had a previous MRSA infection, or if MRSA is common locally.

Recommend broader coverage such as amoxicillin/clavulanate (Augmentin) or levofloxacin (Tavanic) if the patient has taken antibiotics in the past month. Don't worry as much about Pseudomonas in MILD infections, it's more likely to be a problem in more severe infections. Suggest treating only until the infection is resolved, usually 7 to 14 days for mild infections. Explain to patients that the ulcer will take longer to heal.

Suggest broadening coverage or switching to IV therapy if the infection isn't responding. Tell patients that it's more important to keep pressure off the wound than to worry about which wound care product to use. To prevent foot infections, explain the importance of daily foot care, avoiding foot injuries, and good glycemic control.

REFERENCES

• Lipsky, B.A., Berendt, A.R., and others (2012). 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections. Clinical Infectious Diseases, 54(12), pp.e132–e173. Available at: https://pubmed.ncbi.nlm.nih.gov/22619242

  Bader, M.S. and Brooks, A. (2012). Medical Management of Diabetic Foot Infections. Postgraduate Medicine, 124(2), pp.102–113. Available at: https://pubmed.ncbi.nlm.nih.gov/22437220

  Lipsky, B.A., Peters, E.J.G., Senneville, E., Berendt, A.R., Embil, J.M., Lavery, L.A., Urbančič-Rovan, V. and Jeffcoate, W.J. (2012). Expert opinion on the management of infections in the diabetic foot. Diabetes/Metabolism Research and Reviews, 28, pp.163–178. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/dmrr.2248