Treatment
Selecting and Modifying an Antibiotic Regimen
ÎClinically uninfected wounds should NOT be treated with antibiotics (SR-L).
Î
ÎÎPrescribe antibiotics for all infected wounds, but note that this is often
insufficient unless combined with appropriate wound care (SR-L).
ÎÎClinicians should select an empirical antibiotic regimen based on the
severity of the infection and the likely etiologic agent(s) (SR-L).
• For mild to moderate infections in patients who have not recently received antibiotic
treatment, target only aerobic Gram-positive cocci (GPC) (WR-L).
▶▶ Initial empiric therapy should be based on the severity of the infection and on any
available microbiological data, such as recent culture results and the local prevalence
of pathogens, especially antibiotic-resistant strains.
• For most severe infections, start broad-spectrum empiric antibiotics, pending culture
results and antibiotic susceptibility data (SR-L).
• Empiric therapy directed at Pseudomonas aeruginosa is usually unnecessary except for
patients with risk factors for true infection with this organism (SR-L).
• Consider providing empiric therapy directed against methicillin-resistant Staphylococcus
aureus (MRSA) (WR-L):
▶▶ in a patient with a prior history of MRSA infection
▶▶ when the local prevalence of MRSA colonization or infection is high
▶▶ if the infection is clinically severe
ÎÎBase definitive therapy on both the results of an appropriately obtained
culture and sensitivity testing of a wound specimen and the patient's
clinical response to the empiric regimen (SR-L).
ÎÎBase the route of therapy largely on infection severity — parenteral
therapy for all severe, and some moderate, DFIs, at least initially
(WR-L), with a switch to oral agents when the patient is systemically well
and culture results are available.
• Clinicians can probably use highly bioavailable oral antibiotics alone in most mild, and
in many moderate, infections and topical therapy for selected mild superficial infections
(SR-M).
ÎÎContinue antibiotic therapy until, but not beyond, resolution of findings of
infection, but not through complete healing of the wound (WR-L).
• An initial antibiotic course for a soft tissue infection is about 1-2 weeks for mild
infections and 2-3 weeks for moderate to severe infections (WR-L).
Abbreviations
ABI, ankle-brachial index; C&S, culture and sensitivity; CPK, creatine phosphokinase;
DFI, diabetic foot infection; DFO, diabetic foot osteomyelitis; ESBL, extended-spectrum
β-lactamase; FDA, US Food and Drug Administration; GPC, Gram-positive cocci; GRADE,
Grading of Recommendations Assessment, Development and Evaluation; IDSA, Infectious
Diseases Society of America; IV, intravenous; IWGDF, International Working Group on the
Diabetic Foot; MIC, minimum inhibitory concentration; MRI, magnetic resonance imaging;
MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-sensitive S. aureus;
PEDIS, perfusion, extent, depth, infection, sensation (IWGDF research scoring); PO, oral; prn,
as needed; PTB, probe to bone; qid, four times a day; RCT, randomized controlled trial; SIRS,
systemic inflammatory response syndrome; tid, three times a day
