Diabetic Foot Infection

NHSL Antimicrobial Guidelines
NHS Lanarkshire

Duration

Liaise with Diabetologist and consider OPAT.

MILD infection

Therapy

Oral Flucloxacillin5 1g 6 hourly 

Penicillin allergy  

Oral Co-trimoxazole2,10,12,13 960mg 12 hourly 
OR
Oral Clindamycin12 450mg 6 hourly

Notes:

Total duration: Liaise with Diabetologist and consider OPAT.

MODERATE infection

Therapy

IV Flucloxacillin5, 10 2g 6 hourly
+ Oral / IV Metronidazole12  400mg / 500mg 8 hourly

Penicillin allergy  

Oral / IV Co-trimoxazole2,10,12,13 960mg 12 hourly 
+ Oral / IV Metronidazole12  400mg / 500mg 8 hourly 
OR
Oral / IV Clindamycin12 600mg 6 hourly

Notes:

Total Duration: Liaise with Diabetologist and consider OPAT.

SEVERE infection

Therapy

IV Flucloxacillin5, 10 2g 6 hourly 
+ IV Clindamycin 600mg 6 hourly 
+ IV Gentamicin3


Penicillin allergy or MRSA suspected 
IV Vancomycin3
+ IV Clindamycin 600mg 6 hourly
+ IV Gentamicin3

Notes:

Total Duration: Liaise with Diabetologist and consider OPAT.

Notes

Ulcers always colonised. Antibiotics do not improve healing unless active infection.

Notify diabetologist at first opportunity.

Send specimen for culture and review previous microbiology. Sampling for cultures requires cleaning then vigorous curettage and aspiration.

Review antibiotics after culture results.

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
  3. Gentamicin/Vancomycin refer to online calculators.
  4. ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
  5. Monitor sodium.
  6. See CURB65 definition.
  7. Reference: The Renal Drug Handbook. Online access.
  8. See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
  9. Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
  10. Caution in renal impairment – see BNF or pharmacy for advice.
  11. Use with caution may increase K+ and decrease renal function. Monitor.
  12. High / Excellent oral bioavailability, IV route available for NBM or vomiting.
  13. See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Editorial Information

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: January 2024