Antimicrobial prescribing: NHS Forth Valley
Important: Therapy
Flucloxacillin 2g IV 6 hourly
AND
Clindamycin 600mg IV 6 hourly
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.
Important: Therapy
Vancomycin IV as per protocol
AND
Gentamicin IV as per protocol
AND
Clindamycin 600mg IV 6 hourly
Notes:
Important: Therapy
Piperacillin-Tazobactam (Tazocin) 4.5g IV 8 hourly
AND
Clindamycin 600mg IV 6 hourly
Notes:
Important: Therapy
Vancomycin IV as per protocol
AND
Gentamicin IV as per protocol
AND
Clindamycin 600mg IV 6 hourly
Notes:
Important: Therapy
Vancomycin IV as per protocol
AND
Gentamicin IV as per protocol
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