Are diabetic foot-ulcers infected?

• Half are NOT infected
• No good date supporting use of antibiotic will speed up ulcer healing or reduce risk of infection
• But recommend antibiotics when warmth, redness, drainage

Treatment for mild superficial inflammation?

• Gram-positive covering like cephalexin or dicloxacillin
• For patients who's taken antibiotics within past month, consider gram-negatives such as amoxil/ clavunate
• Add MRSA coverage like Doxycyline or TMP/ SMX for history of MRSA or known colonization
• Don't empirically cover Pseudomonas unless risk factors such as recent positive cultures or frequent foot exposure to water (lake, pool)

Treatment for severe inflammation (deeper wounds with erythema 2 cm from wound margin WITHOUT systemic signs, like fever, tachycardia)?

• Amoxil/ Clavunate in most cases, especially suspect anaerobes such as wound with foul odor or necrosis
• Consider IV for those who can't tolerate oral/ not adherence to oral or those with peripheral artery disease
• Gram positive + negative + anaerobes covering: IV piperacillin/ Tazobactam
• Add IV Vancomycin for MRSA risk