New insights in diabetic foot infection

Table 2 Factors to be considered for antibiotic prescription in diabetic foot infection (adapted from reference [17])

Criteria	Comments
Severity of infection	Broad-spectrum therapy via parenteral route for severe infection
Renal dysfunction	Avoid nephrotoxic agents (aminoglycosides, glycopeptides)
Hepatic dysfunction	Avoid hepatotoxic agents (macrolides, amoxicillin/clavulanate)
Ischemic limb	Use relatively high doses of oral antibiotics or prefer IV route to achieve adequate antibiotic level at the site of infection if revascularization procedure is unfeasible
	Consider anti-anaerobic bacteria when there is ischaemia or extensive devitalized tissue
Impaired gastrointestinal function (gastroparesis)	Prefer parenteral route
Local antibiotic resistance patterns	Cover MRSA if indicated
Drug allergies	Review patient's medical history carefully
History of recent antibiotic treatment	May need an extended coverage against gram-negative bacilli and Enterococcus
Chronicity of the wound	Give preference to broad-spectrum therapy initially
Poor therapeutic compliance	Consider IV route and/or hospitalization

MRSA: methicillin-resistant Staphylococcus aureus.