From the Guidelines
The patient's medication refill request for Flagyl should be approved to complete the full course of antibiotic therapy, which is essential for proper wound healing and prevention of infection recurrence, as recommended by the 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections 1. The patient is showing improvement in her left shin wound following subcutaneous debridement performed by wound care on April 1,2025. She is currently taking Flagyl as prescribed and has a follow-up appointment scheduled in 6 days. Her reported reduction in swelling is a positive sign of healing, though the persistent bilateral ankle swelling should be monitored. Her occasional GERD symptoms related to spicy foods suggest dietary modification would be beneficial, and according to the 2006 ACCP evidence-based clinical practice guidelines for chronic cough due to gastroesophageal reflux disease, an intensive medical treatment regimen that includes an antireflux diet, acid suppression with a proton pump inhibitor, and prokinetic therapy may be effective in improving GERD symptoms 1. She should continue to avoid spicy foods and consider over-the-counter antacids as needed for symptom relief. The pending X-ray results should be reviewed at her next appointment to assess bone involvement and guide further treatment. In the meantime, she should continue wound care as directed, keep the area clean and dressed according to wound care instructions, elevate her legs when possible to reduce ankle swelling, and report any increased pain, redness, drainage, or fever that could indicate worsening infection. It is also crucial to assess the affected limb and foot for arterial ischemia, venous insufficiency, and other factors, as recommended by the 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections 1. The patient's overall condition and response to treatment should be closely monitored to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the Research
Patient's Current Condition
- The patient is a 38-year-old female who presented for a follow-up on the wound on her left shin.
- She reports feeling better and has undergone subcutaneous debridement of the wound on her left shin.
- The patient was prescribed Flagyl (metronidazole) and is scheduled for a follow-up in 6-8 days.
Medication and Treatment
- The patient is requesting a refill of her previously prescribed medication.
- Metronidazole has been studied for its use in wound care, including the treatment of wound odor and infection [ 2, 3,4,5,6 ].
- Topical metronidazole has been reported to result in a reduction or eradication of wound odor, decrease in wound drainage, and improvement in wound appearance [ 2 ].
Wound Infection Prophylaxis
- Peri-incisional mezlocillin and rectal metronidazole have been compared for wound infection prophylaxis, with results showing that peri-incisional mezlocillin may be a viable alternative 3.
- Oral metronidazole has been studied for its prophylactic effects on postoperative complications of anal fissure, but results did not support its use 4.
- Metronidazole has been used in combination with cefazolin for wound prophylaxis in head and neck surgical oncology, with results showing a lower rate of wound infection 5.
Controlling Wound Odor
- A systematic review of the literature on the use of metronidazole for controlling wound odor found that the actual effectiveness of metronidazole cannot yet be evidenced due to the absence of strong evidence 6.
- However, clinical practice recommends the use of metronidazole for controlling wound odor, and studies have reported its benefits in reducing wound odor and improving wound appearance [ 2, 6 ].