Medical management of the infected diabetic foot

The underlying principles of medical management are to assess the severity of infection, ascertain the bacteria responsible for the infection and to treat aggressively with antibiotic therapy. Infection is usually graded, mild, moderate or severe. In some circumstances, typical signs of inflammation may be subtle or absent. It is important to have a working knowledge of the principal bacteria involved in these infections and their local antibiotic sensitivities including awareness of antibiotic-resistant organisms. Initial empiric antibiotic therapy for the infected diabetic foot is typically based on the clinical severity of infection and the suspected organisms involved. In every patient, individual sensitivities of organisms isolated on culture should be sought to guide rational and definitive antibiotic therapy. Localised mild infections can generally be treated with oral antibiotics on an outpatient basis aiming to treat Gram-positive bacteria. However, moderate and severe infections which threaten limb or life should initially be treated with broad spectrum intravenous antibiotics to cover Gram-positive and Gram-negative bacteria, and this therapy is then focused according to the microbiology culture results. Severe infections may also need urgent admission to hospital for not only wide spectrum intravenous antibiotics but urgent surgical assessment and possible debridement.