Diabetic Foot Infections - Moderate

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

Micro Organisms

CLINICAL FEATURES OF MODERATE DIABETIC FOOT INFECTION

  • Two or more features of inflammation: Swelling/Induration, Erythema, Pain, Warmth, Pus and
  • Lymphatic streaking, deep tissue involving subcutaneous tissue, tendon, fascia, bone or abscess or
  • Cellulitis >2cm and
  • No evidence of systemic infection

Antibiotic Naive

Therapy

Flucloxacillin 1g PO 6 hourly

(or Flucloxacillin 2g IV 6 hourly if failure already on PO)

AND

Metronidazole 400mg PO 8 hourly

Notes:

Antibiotic Naive - Penicillin Allergy

Therapy

Clindamycin 600mg PO 8 hourly (has good anaerobic cover)

 

or if felt IV required:

Vancomycin IV as per protocol

AND

Metronidazole 400mg PO 8 hourly or 500mg IV 8 hourly

Notes:

Non-Antibiotic Naive

Therapy

Co-amoxiclav 625mg PO 8 hourly

(or Co-amoxiclav 1.2g IV 8 hourly if failure on PO)

Notes:

Non - Antibiotic Naive - Penicillin Allergy

Therapy

Clindamycin 600mg PO 8 hourly

 

or if felt IV required:

Vancomycin IV as per protocol

AND

Metronidazole 400mg PO 8 hourly or 500mg IV 8 hourly

Notes:

MRSA

Therapy

Review antibiotic sensitivities prior to prescribing:

Vancomycin IV as per protocol

or

Co-trimoxazole 960mg PO or IV 12 hourly

or

Clindamycin 600mg IV 6 hourly

Notes:

Notes

TREATMENT DURATION:

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

If osteomyelitis diagnosed will usually require 4-6 weeks antibiotic therapy