The diabetic foot ulcer causes more hospitalizations of people with diabetes than any other diabetic complication. According to the text, "A Practical Approach to Infectious Disease, 4th ed.", diabetics are 17 times more likely to develop gangrene than non-diabetics. Lack of nourishing blood to their extremities caused by damaged blood vessels causes the diabetic's cuts and sores to turn into serious infections. Those infections, once-established, become refractory, or resistant to treatment. These sores urgently need medical attention. Without it, or with possibly failed treatment, the festering wound becomes gangrenous, a condition of tissue death attributed to a lack of blood oxygen supply. GlobalRPh.com lists the antibiotics used today and divides treatment into three categories based on severity of infection. Doses vary at the different stages of the infection.
Mild Diabetic Foot Ulcer Treatment
At this stage, the ulcer has not yet penetrated the deep tissue of the foot. Besides continuing treatment for his diabetes, the person with a beginning ulceration to the foot has a war to wage against bacteria that will invade the compromised area. Staph aureus and strep, normal skin flora, most likely will cause the problem. Taken by mouth, clindamycin, cephalexin, dicloxacillin and augmentin represent the antibiotics used for an ulcer in this stage. If required, hospital intravenous administration of cefazolin, ampicillin-sulbactam, nafcillin or oxacillin, take over.
Complicated Diabetic Foot Ulcer Treatment
The person with complications of the foot ulcer receives treatment in the hospital. A complication could mean another pathogen has invaded the sore or the wound worsened due to developed resistance to the early antibiotics. If the situation appears mild, she receives oral ciprofloxacin and oral metronidazole combined or oral clindamycin by itself. A more severe case would require one intravenous course of treatment as follows: Ampicillin/sulbactam, or ticarcillin/clavulanic acid or piperacillin/tazobactam or one of several cephalosporin antibiotics combined with either metronidazole or clindamycin.
Limb Threatening Diabetic Foot Treatment
The threat of amputation becomes great as the infection advances. By this time, according to "A Practical Approach to Infectious Disease," a number of microbes have joined the picture. At the deepest point of the infection, the anaerobic bacteria live and thrive. Besides staph and strep, enterobacteriaceae such as proteus, klebsiella, E. coli, enterobacter, Morganella morganii, pseudomonas and acinetobacter have moved in. The common anaerobes now in residence include Bacteroides and Clostridium, which contribute to the rotting of tissue, gangrene and the stench of gangrene gases. The infection site now includes the deep layers of skin as well as the lymph nodes and may have reached the joint or involved the bone. Hospitalization and intravenous drugs become mandatory. GlobalRPh.com, 2010, continues the list of antibiotics. The strongest of their kind combine as follows: Clindamycin and ciprofloxacin or tobramycin. Second choice includes the cephalosporins, clindamycin and ceftazidime or cefepime or cefotazime or ceftraxione. Piperacillin with tazobactam comes next. Vancomycin and aztreonam and metronidazole in combination or imipenem or meropenem make up the final choices. The doctor avoids amputation of the limb at all costs. However, an infection this deep has access to the circulatory system and threatens to spread to other organs and body parts. In order to avoid this condition, called sepsis, limb amputation sometimes saves the patient's life.
References
- A Practical Approach to Infectious Disease, 4th ed.; Richard E. Reese, M.D. and Robert F. Betts, M.D.; 1996
- GlobalRPh.com: Infectious Disease Database; 2010
