title: Outpatient management of uncomplicated lower-extremity infections in diabetic patients.
abstract: Most diabetic foot infections are believed to be caused by both aerobic and anaerobic bacteria and to require hospitalization and parenteral antimicrobial therapy. We prospectively evaluated diabetic patients with non-limb-threatening lower-extremity infections not yet treated with antibiotics. The patients were randomized to outpatient treatment with oral clindamycin hydrochloride or cephalexin for 2 weeks and evaluated every 3 to 7 days. In 56 assessable patients, curettage yielded a mean of 2.1 microorganisms. Aerobic gram-positive cocci were isolated in 50 cases (89%), and were the sole pathogen in 21 (42%) of these. Aerobic gram-negative bacilli and anaerobes were isolated in 20 (36%) and 7 (13%) cases, respectively, and almost always in polymicrobial infections. Fifty-one infections (91%) were eradicated, 42 (75%) after 2 weeks of treatment; only 5 (9%) were initially treatment failures, and 3 (5%) were subsequently cured with further outpatient oral antibiotic treatment. After a mean follow-up of 15 months, no further treatment was required in 43 (84%) of the cured patients. Previously untreated lower-extremity infections in diabetic patients are usually caused by aerobic gram-positive cocci, and generally respond well to outpatient management with oral antibiotic therapy.
authors.affiliation: Division of General Internal Medicine, University of Washington School of Medicine, Seattle.
authors.forename: B A
authors.initials: BA
authors.lastname: Lipsky
authors.forename: R E
authors.initials: RE
authors.lastname: Pecoraro
authors.forename: S A
authors.initials: SA
authors.lastname: Larson
authors.forename: M E
authors.initials: ME
authors.lastname: Hanley
authors.forename: J H
authors.initials: JH
authors.lastname: Ahroni
mesh_terms: D000553:Ambulatory Care; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D002506:Cephalexin / Q000627:therapeutic use*; D002981:Clindamycin / Q000627:therapeutic use*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005534:Foot Diseases / Q000188:drug therapy* / Q000209:etiology; D006094:Gram-Positive Bacteria; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
chemical_list: D002981:Clindamycin; D002506:Cephalexin