Treatment of diabetic foot infection: an open randomised comparison of imipenem/cilastatin and piperacillin/clindamycin combination therapy.
OBJECTIVE
To compare the clinical outcome and bacteriological response in diabetic patients with a foot infection treated with imipenem/cilastatin or a combination of piperacillin/clindamycin.


METHODS
Patients hospitalised for diabetic foot lesions Wagner Stages II, III or IV were randomly assigned to receive either imipenem/cilastatin 500 mg QID or piperacillin 3000 mg QID in combination with clindamycin 600 mg TID. Cultures were obtained and clinical observations were made.


RESULTS
Forty-six patients (mean age 71.4 +/- 9.8 years) entered the study, 22 received imipenem/cilastatin (IC) and 24 received piperacillin/clindamycin (PCL) combination therapy. In the IC group 22.2% was considered to be clinically cured, 76.2% improved. In the PCL group this was 25.0% and 50.0%, respectively. In the IC treatment group 45.0% of baseline pathogens was eradicated compared to 70.0% in the PCL group. Adverse events were more often reported in PCL treated patients (50.0% vs. 19.0% P < 0.05).


CONCLUSIONS
Impipenem/cilastatin and piperacillin/clindamycin combination therapy were equally effective in the treatment of patients with diabetic foot lesions. The imipenem/cilastatin regimen caused less side effects.
Paul Bouter
K
K
Department of Internal Medicine, Bosch MediCentre, Deutersestraat 2, 5223 GV Den Bosch, The Netherlands.
Visseren
F L
FL
van Loenhout
R M
RM
Bartelink
A K
AK
Willem Erkelens
D
D
Diepersloot
R J
RJ