What is the best treatment for foot skin infection?

From the Guidelines

For a foot skin infection, the best treatment typically involves antifungal medications if it's a fungal infection like athlete's foot, or antibiotics if it's bacterial, with the selection of antibiotic regimen based on the severity of the infection and the likely etiologic agent(s) 1.

Key Considerations

• The choice of antibiotic should consider the patient's history of antibiotic use, local prevalence of antibiotic-resistant strains, and the severity of the infection.
• For mild infections, oral antibiotics such as cephalexin or clindamycin may be sufficient, while moderate to severe infections may require parenteral therapy initially, with a switch to oral agents when the patient is systemically well and culture results are available 1.
• It is essential to avoid prescribing antibiotics for clinically uninfected wounds, as this can lead to unnecessary harm and drive antibiotic resistance 1.

Treatment Approach

• For fungal infections, over-the-counter antifungal creams containing clotrimazole, miconazole, or terbinafine should be applied to clean, dry feet twice daily for 1-2 weeks, continuing for a week after symptoms resolve.
• For bacterial infections, a healthcare provider may prescribe topical antibiotics like mupirocin or oral antibiotics such as cephalexin (500mg four times daily for 7-10 days) or clindamycin (300mg four times daily for 7-10 days) 1.
• Keep the infected area clean by washing with mild soap and water, dry thoroughly, and avoid walking barefoot.
• Wear breathable footwear and change socks daily.

When to Seek Medical Attention

• If symptoms worsen, include fever, spreading redness, or increasing pain, seek medical attention promptly as this could indicate a more serious infection requiring different treatment.
• Proper foot hygiene prevents recurrence by reducing the moist environment where pathogens thrive.

Surgical Intervention

• Surgery may be necessary for deep soft tissue infections, with the aim of draining deep pus and minimizing tissue necrosis by decompressing foot compartments and removing devitalized and infected tissue 1.
• The decision to perform surgery should be made as part of an interdisciplinary approach, considering proper wound care, treatment of co-morbid medical conditions, and appropriate revascularization (when needed).

From the FDA Drug Label

For the treatment of skin and skin structure infections, the recommended total daily dose is 50 to 75 mg/kg given once a day (or in equally divided doses twice a day). The usual adult daily dose is 1 to 2 grams given once a day (or in equally divided doses twice a day) depending on the type and severity of infection.

The best treatment for foot skin infection is ceftriaxone at a dose of 1 to 2 grams per day for adults, or 50 to 75 mg/kg per day for pediatric patients, given once a day (or in equally divided doses twice a day) depending on the type and severity of infection 2.

From the Research

Treatment Options for Foot Skin Infections

The treatment for foot skin infections can vary depending on the severity and type of infection.

• Topical treatments are often effective for mild to moderate infections, with options including:
  • Allylamines
  • Azoles
  • Ciclopiroxolamine
  • Tolnaftate
  • Butenafine
  • Undecanoates 3
• Oral treatments may be necessary for more severe or chronic infections, with options including:
  • Terbinafine
  • Itraconazole
  • Fluconazole
  • Griseofulvin
  • Ketoconazole 4, 5
• For bacterial skin and skin-structure infections of the foot, cefadroxil has been shown to be effective 6
• In patients with diabetes mellitus, prompt treatment with an antifungal agent is recommended to prevent bacterial superinfection 7

Effectiveness of Treatment Options

• Topical allylamines and azoles have been shown to be effective in treating fungal infections of the skin of the foot, with allylamines curing slightly more infections than azoles 3
• Terbinafine has been shown to be more effective than griseofulvin in treating fungal infections of the skin of the foot 4, 5
• Oral therapy should be limited to patients with more extensive infections, resistant infections, or chronic infections, and should also be considered in diabetic and immunosuppressed patients 7

Considerations for Treatment

• Laboratory diagnosis of fungal infection prior to institution of therapy is recommended 7
• Proper technique for obtaining the specimen is important to ensure a higher chance of isolating the infecting fungus 7
• Treatment of onychomycosis of the foot usually requires systemic therapy, with options including terbinafine, itraconazole, and fluconazole 7