What is the best antibiotic for streptococcal (strep) diabetic foot infection?

From the Guidelines

For a diabetic foot infection caused by strep bacteria, the best initial antibiotic choice is typically amoxicillin-clavulanate (Augmentin) at a dose of 875/125 mg twice daily for 7-14 days, depending on infection severity. This recommendation is based on the most recent and highest quality study available, which suggests that no single drug or combination of agents appears to be superior to any others for the treatment of diabetic foot infections 1.

Key Considerations

• The choice of antibiotic should be guided by the severity of the infection, with mild infections potentially treated with oral agents and more severe infections requiring parenteral therapy.
• The IDSA guideline suggests several antibiotic options for the treatment of diabetic foot infections, including amoxicillin-clavulanate, cephalexin, clindamycin, and levofloxacin, among others 1.
• It is essential to obtain wound cultures before starting antibiotics to confirm the specific bacteria and its sensitivities, as diabetic foot infections often involve multiple bacteria.
• Treatment should be accompanied by proper wound care, blood sugar control, pressure offloading, and regular wound assessment.
• Surgical debridement may be required for deep or necrotic infections.

Antibiotic Options

• For mild infections, oral options like dicloxacillin, clindamycin, cephalexin, levofloxacin, and amoxicillin-clavulanate may be considered 1.
• For more severe infections, parenteral options like ceftriaxone, ampicillin-sulbactam, and vancomycin may be necessary 1.
• The choice of antibiotic should be reassessed after culture results return, potentially allowing for more targeted therapy.

Importance of Prompt Treatment

• Diabetic patients have impaired wound healing and increased risk of complications like osteomyelitis or amputation, making prompt treatment essential.
• The IDSA guideline emphasizes the need for a generally acceptable diabetic foot classification system to standardize severity scoring and improve treatment outcomes 1.

From the FDA Drug Label

The cure rates by pathogen for microbiologically evaluable patients are presented in Table 19. Table 19 Cure Rates at the Test-of-Cure Visit for Microbiologically Evaluable Adult Patients with Diabetic Foot Infections Pathogen Cured ZYVOX n/N (%) Comparator n/N (%) Streptococcus agalactiae 25/29 (86) 9/16 (56)

The best antibiotic for streptococcal (strep) diabetic foot infection is linezolid, with a cure rate of 86% in microbiologically evaluable patients with Streptococcus agalactiae infections 2.

From the Research

Antibiotic Options for Streptococcal Diabetic Foot Infection

• The best antibiotic for streptococcal diabetic foot infection is not explicitly stated in the provided studies, but some antibiotics have shown efficacy against streptococcal infections in diabetic patients 3, 4.
• Linezolid has been shown to be effective against gram-positive cocci, including streptococci, and has been used to treat diabetic foot infections 3, 4.
• Other antibiotics that may be effective against streptococcal infections in diabetic patients include cefoperazone/sulbactam and ceftriaxone 4.
• Novel antibiotics such as cefiderocol and dalbavancin may also be options for treating severe diabetic foot infections caused by multidrug-resistant bacteria, including streptococci 5.

Considerations for Antibiotic Selection

• The selection of an antibiotic for diabetic foot infection should be based on the severity of the infection, the presence of peripheral vascular disease, and the possibility of drug-resistant organisms in the infection 6.
• Empiric antibiotic therapy should include broad-spectrum antibiotics capable of covering the most common pathogens found in diabetic infections, including streptococci 6.
• The development of antibiotic resistance is a concern in the treatment of diabetic foot infections, and the use of novel antibiotics may be necessary to address this issue 5.