DIABETIC FOOT INFECTION AND ANTIBIOTIC OF CHOICE

Diabetic FootA group of human who have suffered Diabetes Mellitus have high risk to get infection be compared with the human who without Diabetes Mellitus. Diabetic foot constitutes chronic complication of diabetes which often be found. The output of medicinal treatment of sufferer who is suffering diabetic foot with infection is often no good. Like that be picked up by Gardner and Frantz, 14-24% sufferer with diabetic foot will endure amputation. Diabetic foot with infection is not only giving medical impact, so big impact of social and economic.

Mechanism of diabetic foot very complex and seldom be effected by single pathology. Generally it’s constituted of two or more interaction cause of. Peripheral neuropathy, peripheral arterial disease, and other risk factor like as foot deformity, joint mobility disorder, micro vascular complication, long diabetes, increasing the pressure of sole of foot, peripheral edema, infection, and foot ulcer or amputation constitute the important factors of diabetic foot incidence.

Diabetic Foot InfectionBy generally, management of diabetic foot case is focused on blood sugar control and therapy of other risk factors. By locally, wound care till to amputate may be done be hanged of severity of diabetic foot. Infection that constitute main problem on diabetic foot so must be cured. Wound infection must be diagnosed in accordance with clinic grounded on finding local inflammatory signs. If be needed like as on osteomyelitis maybe need laboratory examination (include of micro biologic examination). Usually, treatment of diabetic foot is hospitalized and need multidiscipline team. If be needed so participating the specialist of infection disease or medic microbiologist. To treat diabetic foot infection case is needed comprehension cause of microbiologic. One or two microbes indeed poly microbial often mixed up with on diabetic foot infection. Generally on mild diabetic foot infection case is caused by Gram-positive microbe. More than half of infection is caused by Staphylococcus aurous or coagulate-negative Staphylococcus. Staphylococci cause about a third of all cause of which on generally constitute part of poly microbial infection. Gram-negative aerobe and anaerobe microbe are seldom as cause of infection. On moderate infection, Gram-positive microbe still dominant included of Staphylococcus and Streptococcus. However so, percentages of Gram-negative aerobe microbe infection become increasingly large, especially Pseudomonas aerugenosa and Proteus mirabilis. On diabetic foot with severe infection generally is caused by poly microbial.

Broad spectrum antibiotic oral either or parenteral can be used appropriate with degree of infection and grounded on microbe cause of. Many kind of antibiotic that effective be used for various degree of diabetic foot and kind of microbe have been published by Lipsky et al (table 1) and Edmiston et al. Beside that standard therapy, using granulocyte colony-stimulating factor as addition therapy can reduce amputation rate and other surgery measure.

Table 1. Suggested empirical antibiotic regimens, based on clinical severity, for diabetic foot infections.

Route and agent(s)

Mild

Moderate

Severe

Advised route

Oral for most

Oral or parenteral, based on clinical situation and agent(s) selected

Intravenous, at least initially

Dicloxacillin

Yes

Clindamycin

Yes

Cephalexin

Yes

Trimethoprim-sulfamethoxazole

Yes

Yes

Amoxicillin/Clavulanate

Yes

Yes

Levofloxacin

Yes

Yes

Cefoxitin

Yes

Ceptriaxone

Yes

Ampicillin/sulbactam

Yes

Linezolid (with or without aztreonam)

Yes

Daptomycin (with or without aztreonam)

Yes

Ertapenem

Yes

Cefuroxime with or without metronidazole

Yes

Ticarcillin/clavulanate

Yes

Piperacillin/tazobactam

Yes

Yes

Levofloxacin or Ciprofloxacin with clindamycin

Yes

Yes

Imipenem-cilastatin

Yes

Vancomycin and Ceftazidime (with or without metronidazole)

Yes

Definitive regimens should consider results of culture and susceptibility tests, as well as the clinical response to the empirical regimen. Similar agent of the same drug class may be substituted.

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