Detection, management, and prevention of diabetes-related foot disease in the Australian context

Table 3 Spectrum of select antibiotics against common bacteria involved in diabetic foot infections, adapted from the International Working Group on the Diabetic Foot infection guidelines[47]

Antibiotic	Antibiotic spectrum					Oral dose frequency	Pill burden (per day)
	Gram-positive (MSSA, Streptococcus spp.)	Gram-negative (enteric, non-pseudomonal)	Obligate anaerobes	MRSA	Pseudomonal
Penicillins, anti-staphylococcal1	Yes	No	No	No	No	4	4-8
Cefalexin	Yes	Some	No	No	No	4	4-8
Amoxicillin-clavulanate	Yes	Yes	Yes	No	No	2	2
Trimethoprim-sulfamethoxazole	Yes	Yes	No	Some2	No	2	2
Doxycycline	Yes	Some	No	Some2	No	2	2
Clindamycin	Yes	No	Yes	Some2	No	3-4	9-16
Metronidazole3	No	No	Yes	No	No	2-3	2-3
Cefazolin	Yes	Some	No	No	No
Ceftriaxone	Yes	Yes	No	No	No
Piperacillin-tazobactam	Yes	Yes	Yes	No	Yes
Cefepime	Yes	Yes	No	No	Yes
Meropenem	Yes	Yes	Yes	No	Yes
Vancomycin	Yes	No	No	Yes	No
Moxifloxacin	Yes	Yes	Yes	Some2	No	1	1
Ciprofloxacin4	No	Yes	No	No	Yes	2	2

¹Includes flucloxacillin, dicloxacillin, and nafcillin.

²Some methicillin-resistant Staphylococcus aureus (MRSA) strains are resistant, however, in mild cases these oral MRSA-active antibiotics may be considered empirically for patients with MRSA risk.

³Metronidazole should not be used as a single agent, it is often combined with other antibiotics to add anaerobic activity to the regimen.

⁴Ciprofloxacin should not be used as a single agent empirically given the lack of Gram-positive cover, it is often combined with other antibiotics such as clindamycin or vancomycin.

MSSA: Methicillin susceptible Staphylococcus aureus; MRSA: Methicillin-resistant Staphylococcus aureus