Treatment
Table 10. Suggested Route, Setting, and Durations of
Antibiotic Therapy by Clinical Syndrome
Site, by Severity or
Extent, of Infection
Route of
Administration
Setting for
Therapy
Duration of
Therapy
Soft-tissue only
Mild
Topical or oral
Outpatient
1-2 weeks; may
extend up to 4
weeks if slow to
resolve
Moderate
Oral (or initial
parenteral)
Outpatient/
inpatient
1-3 weeks
Severe
Initial parenteral, switch Inpatient, then
to oral when possible
outpatient
2-4 weeks
Bone or joint
No residual infected tissue
(eg, post-amputation)
Parenteral or oral
…
2-5 days
Residual infected soft
tissue (but not bone)
Parenteral or oral
…
1-3 weeks
Residual infected (but
viable) bone
Initial parenteral, then
consider oral switch
…
4-6 weeks
No surgery, or residual
dead bone postoperatively
Initial parenteral, then
consider oral switch
≥ 3 months
Table 11. Signs of a Possible Imminent Limb-Threatening
Infection
Note: In clinical settings with less advanced health care available, lesser degrees of infection
severity may make an infection limb-threatening
• Evidence of systemic inflammatory response
• Rapid progression of infection
• Extensive necrosis or gangrene
• Crepitus on examination or tissue gas on imaging
• Extensive ecchymoses or petechiae
• Bullae, especially hemorrhagic
• New onset wound anesthesia
• Pain out of proportion to clinical findings
• Recent loss of neurologic function
• Critical limb ischemia
• Extensive soft tissue loss
• Extensive bony destruction, especially mid/hind foot
• Failure of infection to improve with appropriate therapy
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