Diabetic Foot Infections (DFIs)


Clinical Considerations

  • NO systemic inflammatory response signs, AND
  • Local infection with erythema >2 cm, OR involving structures deeper than skin and subcutaneous tissues:
    • Abscess
    • Osteomyelitis
    • Septic arthritis
    • Fasciitis
  • Inappropriate and over-prescribing of antibiotics is common for DFIs, which may lead to antibiotic resistance
  • The majority of inpatient moderate cases can use ceftriaxone + metronidazole
  • Levofloxacin: inferior agent for microaerophillic Streptococcus and gram-negatives; no anaerobic coverage
  • Aztreonam: inferior agent for Pseudomonas spp.; no coverage for gram-positives and anaerobes
    Unless previous reaction to penicillin derivative is anaphylaxis, consider a cephalosporin over other agents
    • Refer to “Beta-lactam Allergy Quick Sheet” for further guidance on cross-reactivity and assessment of allergy history


Duration of Treatment

Typically 7-14 days