Diabetic Lower Limb Infection
Diabetic Lower Limb Infections
Bottom Line
- Empiric therapy directed at Pseudomonas aeruginosa is rarely required.
- Empiric therapy for MRSA is not required given low rates at KGH unless the patient has previous history of MRSA infection or MRSA colonization.
- Therapy should be guided based on deep tissue biopsy and not a superficial wound swab.
- Comprehensive coverage includes elevation, non-weight bearing status, wound care, glycemic control and possible debridement.
Empiric Therapy
Treatment based on severity:
- Mild (superficial and limited in size and depth) to moderate (deeper or more extensive) without previous treatment: Therapy targeted at aerobic Gram positive cocci (S. aureus) – Cephalexin
- Chronic , previously treated or severe (accompanied by systemic signs of metabolic perturbation): Therapy targeted at aerobic gram positive cocci, gram negative bacilli and anaerobes: Fluoroquinolone (FQ) or Ceftriaxone + Clindamycin.
- Limb or life threatening: Therapy including obligate anaerobes: Piperacillin/tazobactam