title: Diabetic foot infections: Current treatment and delaying the 'post-antibiotic era'.
abstract: BACKGROUND
  Treatment for diabetic foot infections requires properly diagnosing infection, obtaining an appropriate specimen for culture, assessing for any needed surgical procedures and selecting an empiric antibiotic regimen. Therapy will often need to be modified based on results of culture and sensitivity testing. Because of excessive and inappropriate use of antibiotics for treating diabetic foot infections, resistance to the usually employed bacteria has been increasing to alarming levels.
  
  
  METHODS
  This article reviews recommendations from evidence-based guidelines, informed by results of systematic reviews, on treating diabetic foot infections. Data from the pre-antibiotic era reported rates of mortality of about 9% and of high-level leg amputations of about 70%. Outcomes have greatly improved with appropriate antibiotic therapy. While there are now many oral and parenteral antibiotic agents that have demonstrated efficacy in treating diabetic foot infections, the rate of infection with multidrug-resistant pathogens is growing. This problem requires a multi-focal approach, including providing education to both clinicians and patients, developing robust antimicrobial stewardship programmes and using new diagnostic and therapeutic technologies. Recently, new methods have been developed to find novel antibiotic agents and to resurrect old treatments, like bacteriophages, for treating these difficult infections.
  
  
  CONCLUSIONS
  Medical and political leaders have recognized the serious global threat posed by the growing problem of antibiotic resistance. By a multipronged approach that includes exerting administrative pressure on clinicians to do the right thing, investing in new technologies and encouraging the profitable development of new antimicrobials, we may be able to stave off the coming 'post-antibiotic era'.
authors.affiliation: Division of Medical Sciences, Green Templeton College, University of Oxford, Oxford, UK.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Lipsky
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000639:trends; D003226:Congresses as Topic; D003663:Decision Trees; D017719:Diabetic Foot / Q000150:complications / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D019983:Guideline Adherence; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects / Q000517:prevention & control; D023821:Limb Salvage / Q000009:adverse effects / Q000639:trends; D010349:Patient Compliance; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012720:Severity of Illness Index; D018461:Soft Tissue Infections / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic resistance; antibiotic therapy; diabetic foot infection; infection; post-antibiotic era