Empiric oral antibiotic selection for patients with diabetic foot infection, including osteomyelitis

This algorithm is intended for patients with mild to moderate diabetic foot infections; antibiotic selection for severe infections is outlined in a separate algorithm. Many patients with diabetic foot infection also require surgical intervention, as discussed in UpToDate content. Antibiotic regimens should be changed to target specific pathogens once culture and susceptibility results are available.

IV: intravenous; MRSA: methicillin-resistant Staphylococcus aureus; MSSA: methicillin-sensitive Staphylococcus aureus.

* For patients who are unable to absorb oral antibiotics, an IV regimen with a spectrum similar to the appropriate oral option should be chosen.

¶ By definition, patients with osteomyelitis have either moderate or severe infection (refer to inset 1).

Δ Other risk factors may not be as strongly associated with MRSA infection, so we individualize the decision to cover MRSA in such cases. A complete list of MRSA risk factors can be found in UpToDate content.

◊ We generally avoid clindamycin, if possible, due to risk of Clostridioides difficile infection and the possibility of streptococcal and staphylococcal resistance (refer to UpToDate content for details).

§ For patients with osteomyelitis who have received recent antibiotics and have no available deep culture results, some experts add double coverage for Enterobacterales (eg, E. coli, Klebsiella) with regimens such as amoxicillin-clavulanate plus either doxycycline or trimethoprim-sulfamethoxazole.

Graphic 145168 Version 2.0

خرید پکیج

Empiric oral antibiotic selection for patients with diabetic foot infection, including osteomyelitis