Diabetic Foot Infections - Severe

Micro Organisms

CLINICAL FEATURES OF SEVERE DIABETIC FOOT INFECTION:

Any infection accompanied by systemic toxicity (fever, chills, shock, vomiting, confusion, metabolic instability).

The presence of critical ischaemia of involved limb may make the infection severe.

Antibiotic Naive

Important: Therapy

Flucloxacillin 2g IV 6 hourly

AND

Clindamycin 600mg IV 6 hourly

Notes:

Antibiotic Naive - Penicillin Allergy

Important: Therapy

Vancomycin IV (as per online calculator)

AND

Gentamicin IV (as per online calculator)

AND

Clindamycin 600mg IV 6 hourly

Notes:

Non-Antibiotic Naive - First Line

Important: Therapy

Piperacillin-Tazobactam (Tazocin) 4.5g IV 8 hourly

AND

Clindamycin 600mg IV 6 hourly

Notes:

Non-Antibiotice Naive - Penicillin Allergy

Important: Therapy

Vancomycin IV (as per online calculator)

AND

Gentamicin IV (as per online calculator)

AND

Clindamycin 600mg IV 6 hourly

Notes:

MRSA

Important: Therapy

Vancomycin IV (as per online calculator)

AND

Gentamicin IV (as per online calculator)

AND

Clindamycin 600mg IV 6 hourly

Notes:

Important: Notes

TREATMENT DURATION:

7-10 days total (including IV and oral) May need up to 14 days if slow clinical response

Review need for ongoing Gram negative cover (e.g. gentamicin) and rationalise therapy based on microbiology results available.

If osteomyelitis diagnosed, discuss with consultant microbiologist.

AKI guidance:

If there is significant AKI – replace Gentamicin with Aztreonam IV (dose as per renal drug book /database)

Oral switch guidance:

Review recent microbiology. Growth from non-sterile sites e.g. superficial swabs can reflect colonisation rather than infection and results need to be reviewed with response to empirical antibiotics.

IV flucloxacillin + clindamycin = Flucloxacillin 1g PO 6 hourly

IV piperacillin-tazobactam + clindamycin = Co-amoxiclav 625 mg PO 8 hourly

IV vancomycin + gentamicin + clindamycin = Co-trimoxazole 960mg PO 12 hourly