Oral agents for empiric treatment of mild to moderate diabetic foot infections

Regimens with activity against streptococci and staphylococci (MSSA)
Cephalexin or
Dicloxacillin or
Amoxicillin-clavulanate or
Clindamycin
Regimens with activity against streptococci and MRSA
Clindamycin* or
Linezolid or
Cephalexin or dicloxacillin PLUS Trimethoprim-sulfamethoxazole or doxycycline
Regimens with activity against streptococci, MRSA, aerobic gram-negative bacilli^¶ and anaerobes
Trimethoprim-sulfamethoxazole PLUS Amoxicillin-clavulanate or Moxifloxacin -OR-
Clindamycin* PLUS Ciprofloxacin^¶ or Levofloxacin^¶
Antibiotic dosing for adults with normal renal function^Δ
Cephalexin	500 mg every 6 hours
Dicloxacillin	500 mg every 6 hours
Clindamycin	300 to 450 mg every 6 to 8 hours
Linezolid	600 mg every 12 hours
Trimethoprim-sulfamethoxazole (co-trimoxazole)	2 double-strength tablets (trimethoprim 160 mg and sulfamethoxazole 800 mg per tablet) every 12 hours
Doxycycline	100 mg orally every 12 hours
Amoxicillin-clavulanate	875/125 mg every 12 hours
Ciprofloxacin	500 mg every 12 hours (or, if there is concern for Pseudomonas aeruginosa, 750 mg every 12 hours)
Levofloxacin	500 mg every 24 hours (or, if there is concern for P. aeruginosa, 750 mg every 24 hours)
Moxifloxacin^◊	400 mg every 24 hours

MSSA: methicillin-susceptible Staphylococcus aureus; MRSA: methicillin-resistant S. aureus.
* Check susceptibility testing.
¶ Only the regimens containing ciprofloxacin or levofloxacin have expected activity against Pseudomonas aeruginosa. Empiric coverage for P. aeruginosa may not be necessary unless the patient has a particular risk for involvement with this organism, such as a macerated wound or one with significant water exposure. When there is concern for P. aeruginosa, higher dosing of ciprofloxacin or levofloxacin is appropriate, as described in the dosing section above.
Δ Many of these agents require adjustment of the dose in the setting of renal dysfunction.
◊ Moxifloxacin is not recommended for the treatment of P. aeruginosa.

Data courtesy of authors with additional data from: Lipsky BA, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54:e132.

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Oral agents for empiric treatment of mild to moderate diabetic foot infections