Treatment
Table 10. Suggested Route, Setting, and Durations of Antibiotic Therapy by Clinical Syndrome
Site, by Severity or Extent, of Infection
Soſt-tissue only Mild
Moderate Severe
Bone or joint
No residual infected tissue (eg, post-amputation)
Residual infected soft tissue (but not bone)
Residual infected (but viable) bone
No surgery, or residual dead bone postoperatively
Parenteral or oral Parenteral or oral
Initial parenteral, then consider oral switch
Initial parenteral, then consider oral switch
…
… …
2-5 days
1-3 weeks 4-6 weeks ≥ 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
12
Route of Administration
Topical or oral
Oral (or initial parenteral)
Initial parenteral, switch to oral when possible
Setting for Therapy
Outpatient
Outpatient/ inpatient
Inpatient, then outpatient
Duration of Therapy
weeks if slow to resolve
1-2 weeks; may extend up to 4
1-3 weeks 2-4 weeks
