Oral combination of amoxicillin‐clavulanate (AMC) is an effective antibiotic regimen for diabetic foot infections: revealed a retrospective cohort study The study was published in the DOM, journal of pharmacology and therapeutics.
As, some clinicians avoid amoxicillin‐clavulanate (AMC) for the oral therapy of diabetic foot infections (DFI), especially for osteomyelitis (DFO), due to its poor bioavailability and bone penetration of all antibiotics from the β‐lactam class. In this study, the authors have performed a retrospective cohort analysis among 794 DFI episodes, including 339 DFO cases. The median duration of antibiotic therapy after surgical debridement (including partial amputation) was 30 days (DFO 30 days). Oral AMC was prescribed for a median of 20 days. The median ratio of oral AMC among the entire antibiotic treatment was 0.9. After a median follow‐up of 3.3 years, 178 DFIs overall recurred. In multivariate analyses and stratified subgroup analyses, oral AMC resulted in similar clinical outcomes to other antimicrobial regimens; either when used orally from the start, after initial parenteral therapy, or when prescribed for DFOs. We conclude that oral AMC is a reasonable option when treating patients with DFIs and DFOs.
DFI is the most common complication of diabetes mellitus leading to hospitalization and the most frequent cause of non-traumatic lower extremity amputation. It is defined as soft tissue and bone infection under malleoli. Most diabetic foot infections are polymicrobial and the most common pathogens in diabetic foot infection are aerobic gram-positive cocci, mainly Staphylococcus species.
Methicillin-resistant Staphylococcus aureus is present in 10% to 32% of diabetic infections and is associated with a higher rate of treatment failure in patients with a diabetic foot infection. Osteomyelitis is a serious complication of diabetic foot infection that increases the likelihood of surgical intervention. The treatment depends on the severity of the infection. Mild infections are treated with oral antibiotics, wound care, and pressure off-loading in the outpatient setting. Selected patients with moderate infections and all patients with severe infections should be hospitalized, given intravenous antibiotics, and evaluated for possible surgical intervention.
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