From the Guidelines
Oral antibiotics recommended for foot wound infections pending culture results include those effective against aerobic gram-positive cocci, such as Staphylococcus aureus and Streptococcus species.
Key Considerations
- For mild to moderate infections in patients without recent antibiotic use, therapy targeting aerobic gram-positive cocci (GPC) may be sufficient 1.
- In areas with high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) or in patients with a history of MRSA infection, consider empiric therapy directed against MRSA 2.
- For severe infections, broad-spectrum empiric antibiotic therapy is recommended, pending culture results and antibiotic susceptibility data 3.
Recommended Oral Antibiotics
- Cephalexin or Dicloxacillin for infections suspected to be caused by aerobic GPC 1.
- Clindamycin or Trimethoprim-sulfamethoxazole for infections suspected to be caused by MRSA 2.
- Amoxicillin-clavulanate or Moxifloxacin for broad-spectrum coverage in severe infections 4.
Important Notes
- The choice of antibiotic should be based on the severity of the infection, the likely etiologic agent, and local antibiotic susceptibility data 5.
- Definitive therapy should be based on culture results and susceptibility data, as well as the patient's clinical response to the empiric regimen 1.
- The duration of antibiotic therapy should be until resolution of findings of infection, but not necessarily until the wound has healed 3.
From the Research
Oral Antibiotics for Foot Wound Infections
The following oral antibiotics are recommended for foot wound infections pending culture results:
- For mild infections, narrow-spectrum oral antibiotics such as those active against staphylococci and streptococci can be used 6, 7, 8
- For moderate to severe infections, broad-spectrum oral antibiotics may be necessary, with consideration of the patient's recent antibiotic use and local antibiotic susceptibility data 9, 7, 8
- Fluoroquinolones may be an option for oral therapy, as they have been shown to achieve therapeutic levels in infected foot tissues 6
Key Considerations
- The choice of antibiotic should be based on the severity of the infection, the likely etiologic agent(s), and the patient's clinical response 9, 7, 8
- Empirical antibiotic therapy should be modified based on culture results and antibiotic susceptibility data 6, 9, 7
- The duration of antibiotic therapy ranges from 1-2 weeks for mild soft tissue infections to over 6 weeks for osteomyelitis 6, 9, 7
Specific Antibiotic Options
- Ertapenem with or without vancomycin has been shown to be effective in achieving clinical resolution of infection 10
- Carbapenems combined with anti-pseudomonal agents may produce fewer adverse effects than anti-pseudomonal penicillins 10
- Daptomycin may produce fewer adverse effects than vancomycin or other semi-synthetic penicillins 10