Diabetic Foot Infection: Antimicrobial Prescribing

Background In diabetes, all foot wounds are likely to be colonised with bacteria Diabetic foot infection has at least 2 of:

• local swelling or induration

• erythema

• local tenderness or pain

• local warmth

• purulent discharge

Severity is classified as:

• Mild - local infection with 0.5 to less than 2 cm erythema

• Moderate - local infection with more than 2 cm erythema or involving deeper structures (such as abscess, osteomyelitis, septic arthritis or fasciitis)

• Severe - local infection with signs of a systemic inflammatory response

Prescribing considerations

When choosing an antibiotic, take account of:

• the severity of infection (mild, moderate or severe)

• the risk of complications

• previous microbiological results

• previous antibiotic use

• patient preference

Give oral antibiotics first line if possible Review intravenous antibiotics by 48 hours and consider switching to oral antibiotics if possible Review need for continued antibiotics regularly