In diabetic foot infections antibiotics are to treat infection, not to heal wounds.
BACKGROUND
Diabetic foot ulcers, especially when they become infected, are a leading cause of morbidity and may lead to severe consequences, such as amputation. Optimal treatment of these diabetic foot problems usually requires a multidisciplinary approach, typically including wound debridement, pressure off-loading, glycemic control, surgical interventions and occasionally other adjunctive measures.


METHODS
Antibiotic therapy is required for most clinically infected wounds, but not for uninfected ulcers. Unfortunately, clinicians often prescribe antibiotics when they are not indicated, and even when indicated the regimen is frequently broader spectrum than needed and given for longer than necessary. Many agents are available for intravenous, oral or topical therapy, but no single antibiotic or combination is optimal. Overuse of antibiotics has negative effects for the patient, the health care system and society. Unnecessary antibiotic therapy further promotes the problem of antibiotic resistance.


CONCLUSIONS
The rationale for prescribing topical, oral or parenteral antibiotics for patients with a diabetic foot wound is to treat clinically evident infection. Available published evidence suggests that there is no reason to prescribe antibiotic therapy for an uninfected foot wound as either prophylaxis against infection or in the hope that it will hasten healing of the wound.
University of Geneva, Geneva University Hospitals and Medical School, Service of Infectious Diseases , 4, rue Gabrielle Perret-Gentil, 1211 Geneva 14 , Switzerland +41 22 372 33 11 ; ilker.uckay@hcuge.ch.
Mohamed
M
Abbas
Ilker
I
Uçkay
Benjamin A
BA
Lipsky
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017719:Diabetic Foot / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D024881:Drug Resistance, Bacterial; D006801:Humans; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology; D014945:Wound Healing / Q000187:drug effects*; D014946:Wound Infection / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology
D000900:Anti-Bacterial Agents
antibiotic therapy; diabetic foot; foot infection; foot ulcer; topical antimicrobials; wound healing