From the Guidelines
Treatment of cellulitis with diabetic foot ulcer requires a multidisciplinary approach, including prompt antibiotic therapy, proper wound care, and glycemic control, as recommended by the most recent guidelines 1. The management of cellulitis with diabetic foot ulcer involves several key components, including:
- Antibiotic therapy: selecting specific antibiotic agents based on the likely or proven causative pathogens, their antibiotic susceptibilities, the clinical severity of the infection, evidence of efficacy for DFI, and costs 1
- Wound care: regular cleansing with saline, debridement of necrotic tissue, and appropriate dressings to maintain a moist wound environment, with dressings selected principally on the basis of exudate control, comfort, and cost 1
- Glycemic control: maintaining blood glucose levels between 140-180 mg/dL during treatment
- Offloading pressure from the ulcer using specialized footwear, casts, or wheelchairs
- Regular follow-up with a multidisciplinary team, including endocrinology, infectious disease, and podiatry specialists, to monitor healing progress It is essential to assess the severity of ulcers before treatment and consider referral to special units in cases of rapid changes in skin color, exacerbation of local pain with redness and swelling, newly developed ulcers, deterioration of the original ulcers, and involvement of soft tissue and/or bone tissue, disseminated cellulitis, signs of systemic infection, or osteomyelitis 1. The use of interventions such as hyperbaric oxygen therapy, negative pressure wound therapy, and placental-derived products may be considered as adjunctive treatments in specific cases, but their use should be based on individual patient needs and the latest evidence-based guidelines 1.
From the Research
Diabetic Foot Ulcer Treatment
- The treatment of diabetic foot ulcers (DFUs) is complex and requires a multifaceted approach, including wound care, management of underlying conditions such as peripheral neuropathy and poor circulation, and control of glycemic levels 2.
- Topical hydrocolloid-based hydrogel dressings or honey can facilitate moist wound healing and debridement in DFUs 2.
- The use of negative pressure wound therapy (NPWT) has been shown to be effective in treating DFUs, particularly in patients with Wagner grade 2,3, or 4 ulcers 2.
Cellulitis Treatment in Diabetic Foot Ulcers
- Cellulitis in DFUs requires prompt treatment with antibiotics, and the choice of antibiotic should be guided by tissue culture results whenever possible 3, 4.
- Empirical antibiotic therapy may increase the risk of hospitalization in patients with infected DFUs, particularly those with mild infections 3.
- Oral amoxicillin-clavulanate has been shown to be effective in treating diabetic foot infections, including osteomyelitis, and can be used as an alternative to parenteral therapy 5.
Management of Diabetic Foot Infections
- The International Working Group on the Diabetic Foot (IWGDF) has published guidelines on the diagnosis and treatment of foot infections in persons with diabetes, which emphasize the importance of prompt diagnosis, appropriate antibiotic therapy, and surgical intervention when necessary 4.
- The guidelines also recommend the use of adjunctive treatments such as offloading and wound care to promote healing and prevent recurrence 4.