Pharmacologic Treatment

The severity of a patient's infection, based on the PEDIS scale, guides the selection of empirical antimicrobial therapy. While most patients with grade 2 diabetic foot infections can be treated as outpatients with oral antimicrobial agents, all grade 4 and many grade 3 infections require hospitalization, stabilization of the patient, and broad-spectrum IV antibiotic therapy.34

Table 73-6 Empirical Pharmacologic Treatment of Diabetic Foot Infection

PEDIS Ginin! Apprciih ha Empirical En impl» of ftp pjn prijtc Infection Severity Ggdt_Pharmacologic Treatment_ Empirical AntibJotki'_

Uninfected 1 None. Avoid treating u"«1ixtcd diabetic fool ulceri Hut applicable

Mild 1 Ojl. i\)ir(^/-spcttiunft jfiiitiMiL therJpr willl Jilivlry rw luW-ttfti (LUDhJleainL [Stkjur .llin, againu Uaphyloaxajiau/eui artf itwptococcal or clindamycin species Include ccwefsge Fa MR5A(HA-of CA- HA-MtSAiusp««]onwln{IYXIinMalid, MR5AJ JCCOrdifKHO f^yiii'nt liktOtyarKl id,Sd\r.i,yr or il.b|iriKnyi in ¡IV) patterns In the aiea t A-MltiA Suspected: clindamycin^, trimethofxim sulfametho»a2o4cr or «liMyt^i l:r>"

Moderate i DdfKult define a genera" apfxiwh. in irany Oral opi inns Irc Giade t infernom:

palients. highly bkuvjilatile oral therapy Is AmpnlcilirvclaWianaGe, levoflaocin-' *■ aHJiOU1 idtf IV itwjpy sIhjjVJ be irtitklkll in CliridSiiyClrt, <X rrnintludjC ii i piHienis with moref«teniiwe or chronic irfeitkm^ CA-Mfl$A mifpecieifcinchrrtecllndamjrln*, or those wflh abscesv deeptiwue or bone tiimHhoprim yjBametho*ivci|por dcnycyctne _invoMwont e> ganqiQfK?_

Severe 4 Parenteral, brodd spectrum anhbiotlc lhetapy 'Ji-qjjI'Í w options Ioí Grade i-4 infection.

be ¡niiüied. kiMiiy drugs with stilly ipjinsi grdm- vaiKorriyt¡h.(iaiMOrtijtiri,Of lincKHicr pcKjflve, tjram- necjstive, and anawohic hactsia Di ncmbinailon with one of the fnikwflng lOccwd. inciudt tovci j^o toi musa p^perjt^ivBíObKtW. ünpKBi(vst*)íCBnx

*F1c«c relcr roTjHe ?i 3 lor dosing in adults-»«ilh normal renal lurxlion.

MJRA ¡yétales aislan! toifyllnumnin should be tvalujUisi ío< »iducitií? clindamycin resistance™ a D to!. T.¡m¡Dsü ciiníciil tfau e*¡si ta Hit utiiment of MRS* inreciicm. Poor at i wry »gain« GAS; mm«« using in ccímtiinacion- wlhclintbrnxln en

'Mfl^A poverífie iní1i:.ití(3 fen patents wirh seveie cellulitis or syswynic illness, u/hom hí.-^ífji fsdtss far HA MfiíAor CA-MflSft infwiicn, Oi re^-de in areas with hxili C A-MflSA prevalere e Othenwse, 1tie broad-sp«tmm regimens listed below, wrltiout ^IW A ori/erage, ane appropriate.

'Tlgetychne is not currently approved for the treatmem of diabetic (dot indentions.

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