Evidence of clinical infection
cellulitis
regional adenopathy
extensive ulceration
fever
If osteomyelitis suspected/documented see Osteomyelitis.
- Deep cultures from cleaned ulcer base recommended.
- 25% of decubitus ulcers have underlying osteomyelitis.
Usual Pathogens
Polymicrobial:
S. aureus/MRSA
ß-haemolytic Streptococci (group A,B,C,G)
Enterococcus spp
Enterobacterales
Pseudomonas spp
Anaerobes
Mild
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid |
Penicillin/amoxicillin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Cefuroxime axetil | 500mg PO bid | |
| + | ||
| Metronidazole | 500mg PO bid |
Cefuroxime allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Doxycycline | 100mg PO bid | |
| + | ||
| Metronidazole | 500mg PO bid |
MRSA suspected
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid | |
| + |
|
|
| 2DS tabs PO bid |
|
|
| Amoxicillin/penicillin allergy |
|
|
| Doxycycline | 100mg PO bid | |
| + |
|
|
| Metronidazole | 500mg PO bid |
|
Moderate-severe
| Empiric Therapy | Duration | |
|---|---|---|
| Cefazolin | 2g IV q8h | |
| + | ||
| Metronidazole | 500mg PO bid |
Cefazolin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Ceftriaxone | 2g IV daily | 7-14 days |
| + | ||
| Metronidazole IV/PO | 500mg IV/PO q12h |
For other parenteral regimens see Diabetic foot infection.