treatment of Diabetic foot infections and Impetigo skin choose antibiotic

Diabetic foot infections                                                                                                          DEFINITION  

Management

Antibiotics (and culture) are not necessary unless there are signs of infection in the wound. However, in people with diabetes and other conditions where perfusion and immune response are diminished, classical clinical signs of infection are not always present, so the threshold for suspecting infection and testing a wound should be lower.

Referral to hospital should be considered if it is suspected that the infection involves the bones of the feet, if there is no sign of healing after four weeks of treatment, or if other complications develop.

Common pathogens

Early infection is usually due to Staphylococcus aureus and/or streptococci. Later infection may be polymicrobial with a mixture of Gram-positive cocci, Gram-negative bacilli and anaerobes

Antibiotic treatment
Diabetic foot infections

First choice
Amoxicillin clavulanate

Adult: 500+125 mg, three times daily, for five to seven days

Alternatives

Cephalexin 500 mg, four times daily, + metronidazole 400 mg, twice to three times daily, for five to seven days

OR (for patients with penicillin hypersensitivity)

Co-trimoxazole 160+800 mg (two tablets), twice daily, + clindamycin* 300 mg, three times daily, for 

five to seven days

(2)  Impetigo

  Management

Remove crusted area and apply topical antibiotic ointment to localised areas of impetigo. Keep affected areas covered and exclude from school or preschool until 24 hours after treatment initiated. Assess and treat other infected household members.

Oral antibiotics are recommended for more extensive, widespread, impetigo, or if systemic symptoms are present.

Recurrent impetigo may be the result of chronic nasal carriage of Staphylococcus aureus (patient or household contact), or re-infection from fomite colonisation, e.g. clothing, linen, and may require decolonisation.

N.B. Streptococcus pyogenes has caused outbreaks of necrotising fasciitis in residential care facilities, and if this is suspected it is important to use systemic treatment to eradicate carriage, and prevent infection to others        

 Common pathogens

Streptococcus pyogenes, Staphylococcus aureus

Antibiotic treatment
Impetigo

First choice
Topical (localised patches):

Fusidic acid 2% cream or ointment applied three times daily, for seven days

Oral (extensive lesions):

Flucloxacillin

Child: 12.5 mg/kg/dose four times daily, for seven days (maximum 500 mg/dose)

Adult: 500 mg, four times daily, for seven days

OR

Cephalexin

Child: 12–25 mg/kg/dose, twice daily, for seven days

Adult: 500 mg, four times daily or 1 g, twice daily, for seven days

Alternatives

If topical treatment fails, use oral treatment as above.

Erythromycin (alternative oral treatment)

Child aged < 12 years: 20 mg/kg/dose, twice daily, or 10 mg/kg/dose, four times daily, for seven to ten days (maximum 1 g/day)

Adult: 800 mg, twice daily, or 400 mg, four times daily, for seven days

Co-trimoxazole (if MRSA present)

Child > 6 weeks: 0.5 mL/kg/dose oral liquid (40+200 mg/5 mL), twice daily, for five to seven days (maximum 20 mL/dose)

N.B. Co-trimoxazole should be avoided in infants aged under six weeks, due to the risk of hyperbilirubinaemia.

Adult and child > 12 years: 160+800 mg (two tablets), twice daily,FOR SEVEN DAYS