9.7 Diabetic foot infections (DFI)
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Mild: local infection with 0.5cm to < 2cm erythema | Cloxacillin 500 mg q6h Or Cephalexin 500 mg q6h Or Cefadroxil 500 mg q12h Duration: 1 to 2 weeks based on clinical response | Sulfamethoxazole/trim ethoprim (Bactrim) 160/800 mg orally BD Or Doxycycline 200mg on day 1, then 100mg OD (can be increased to 200mg daily) | Start antibiotic treatment as soon as possible. Take samples for microbiological testing before, or as close as possible to the start of treatment. When choosing an antibiotic, take account of severity, risk of complications, previous microbiological results and antibiotic use. Empiric antibiotic regimen should include an agent active against Staphylococcus aureus, including methicillin-resistant S. aureus if necessary, and Streptococci. Surgery is the cornerstone of treatment for deep diabetic foot infections. Procedures range from simple incision and drainage to extensive multiple surgical debridement and amputation. |
| Moderate: local infection with > 2cm erythema or involving deeper structures (such as abscess, osteomyelitis, septic arthritis or fasciitis) | |||
| Severe: local infection with signs of a systemic inflammatory response. |
For common etiological agents of Diabetic foot infections (DFI), see Annexure B.9.7
Additional Information
- For culture, tissue specimen (collected by curettage or biopsy) is preferred over swabs in soft tissue DFI. The sensitivity and specificity are higher for tissue specimens, though sampling from tissue requires training and may pose a minimal risk of discomfort or bleeding.
References
1. Diabetes Metab Res Rev. 2020;36(S1):e3280. Available at https://doi.org/10.1002/dmrr.3280
2. Eric Senneville, Zaina Albalawi, Suzanne A van Asten, Zulfiqarali G Abbas, Geneve Allison, Javier Aragón-Sánchez, John M Embil, Lawrence A Lavery, Majdi Alhasan, Orhan Oz, Ilker Uçkay, Vilma Urbančič-Rovan, Zhang-Rong Xu, Edgar J G Peters, IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023), Clinical Infectious Diseases, 2023;, ciad527, https://doi.org/10.1093/cid/ciad527