Diabetic foot ulcers

Prescribing Notes:

• Please refer to local guidance on management of foot ulcers.
  • NHS Borders (LINK BEING UPDATED)
  • NHS Fife diabetic foot guidance
  • NHS Lothian diabetic foot infection guidance
• When selecting an antibiotic consider risk factors for Clostridium difficile infection (CDI). Treatment with co-amoxiclav or ciprofloxacin or clindamycin has a higher association with subsequent CDI, than flucloxacillin or doxycycline or co-trimoxazole.
• Antibiotics are not required for ulceration without surrounding skin infection.
• Consider need to investigate bone infection in diabetic patients or those with chronic ulceration.
• Antibiotics alone will not heal diabetic foot ulcers. All patients with diabetic foot ulcers should be managed in a multidisciplinary foot-care setting. Attention must also be given to diabetic control, peripheral circulation, pressure relief, suitable dressings and regular debridement by a podiatrist. Antibiotic therapy should be initiated in the diabetic foot clinic guided by specimens taken by the diabetic podiatrist.
• Superficial swabs may grow colonising organisms and not reflect the infecting organism.
• Occasionally polymicrobial infection is present and may require antibiotics to cover Pseudomonas, S. aureus and anaerobes unless pathogen is known from deep sample.
• Seven days of antibiotics are usually sufficient for superficial skin infection associated with skin ulceration. If bony infection is confirmed treatment may need to be based on response up to 4-6 weeks.