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

Table 4 Empirical antibiotic choices in diabetes-related foot disease; adapted from the International Working Group on the Diabetic Foot infection guidelines[47]

IWGDF classification	Example of Empirical Antibiotic	If MRSA Risk1
Mild (grade 2) – no recent antibiotics	Flucloxacillin PO, or cefalexin PO	As a single agent clindamycin PO, or trimethoprim-sulfamethoxazole PO, or doxycycline PO
Mild (grade 2) – recent antibiotics or water-immersed wound	Amoxicillin-clavulanate PO	Add one of the agents above, OR as a single agent moxifloxacin PO
Moderate (grade 3)	Amoxicillin-clavulanate PO/IV	Add one of the agents above, or if IV required, add vancomycin IV
	Or cefazolin IV plus metronidazole PO/IV
	Or if Pseudomonas risk2, piperacillin-tazobactam IV
Severe (grade 4)	Piperacillin-tazobactam IV	Add vancomycin IV

¹Risk factors for methicillin-resistant S. aureus (MRSA) include previous colonisation with MRSA, residence in a community, aged-care facility, or correctional facility with high MRSA prevalence, and frequent or prolonged stay in a hospital with a high prevalence of MRSA.

²Risk factors for Pseudomonas infection include positive Pseudomonas microbiology in previous few weeks or located in a tropical/sub-tropical climate area.

IV: Intravenous; IWGDF: International Working Group on the Diabetic Foot; MRSA: Methicillin-resistant Staphylococcus aureus; PO: Oral.