°°°?????????
235
Inpatientswithosteomyelitis,antibiotictherapybased
Antibioticregimens
oncultureresultsofbone,asopposedtowoundswabs,
maybemoretargetedandimproveoutcomes.Treat-
Clinicallyuninfectedwoundsdonotrequireantimicro-
mentdurationcanlikelybebasedontheextentof
bialtherapy.
residualsofttissueorboneinfectionanddeadbone,
Forclinicallyinfectedwounds,theselectedantibiotic
afteranysurgicalprocedure.
regimenshouldbeastargetedtolikelypathogensand
Fewdatainformdecisionsonthecost-effectivenessof
asnarrowspectrumaspossible.
variousantibioticregimens.
Culturesofsupercialswabsoftenyieldcontaminants,
butthoseofdeeptissuespecimens(afterdebridement)
assistinoptimizingantibioticselection.
Adjunctivetreatments
Initialantibiotictherapyisusuallyempirical,andthe
regimenshouldincludeactivityagainstStaphylococcus
Noconvincingevidencesupportstheuseoftopical
aureusandaerobicstreptococci.Consideragentsactive
antimicrobialsforinfectedoruninfecteddiabeticfoot
againstmethicillin-resistantS.aureusforpatientwith
wounds.
riskfactorsforthispathogenorifthelocalprevalence
Thechoiceofadressingshouldbebasedmainlyon
ishigh.Agentsdirectedagainstgram-negativeorgan-
whetherthewoundisexudativeordry.
ismsareappropriateinpatientswithsevereinfection
Studiesongranulocytecolony-stimulatingfactorshave
orinareaswheretheirprevalenceishigh.
reportedmixedresultsonvariousoutcomesofdiabetic
Whencultureandsensitivityresultsareavailable,con-
footinfection.
siderachangetoamorespecicregimentargetedjust
Noconvincingevidencesupportstheuseofother
attheisolatedpathogensbutalsoconsidertheclinical
adjunctivetherapiesinthetreatmentofdiabeticfoot
responsetotheempiricaltreatment.
infections.
Availabledatadonotfavouranyparticularantibiotic
treatmentstrategy,thatis,specicantibioticclassor
agent,routeordurationoftherapy.Conictofinterest
Severeinfectionsrequireparenteraltherapy(atleastBALhasservedasaconsultanttoMerck,Pzer,Cubist,
fortherstfewdays),butmildandmostmoderateDiPexium,Johnson&Johnson.ARBwasaPzerVisiting
infectionscanbetreatedwithoralantibioticsthatProfessorin2011totheUniversityofWashingtonDepart-
arehighlybioavailable.mentofAllergyandInfectiousDiseases,aneducationally
Parenteralagentsmayalsoberequiredforthoseun-unrestrictedprogrammeforwhichfundingwasawarded
abletotolerateoralagentsorwhoareinfectedwithtoDAIDonapeerreviewedandcompetitivebasis.ARBre-
pathogensresistanttoavailableoralagents.ceivednopersonalnancialbenetfromthisprogramme.
OnlylimitedevidencesupportstheuseofselectedEShasservedasaninvestigatorintheEU-COREdatabase
topicalantibioticsfortreatinginfectedwounds.study(NOVARTIS).
Copyright?2012JohnWiley&Sons,Ltd.DiabetesMetabResRev2012;28(Suppl1):234–235.
DOI:10.1002/dmrr |
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