Is it acceptable to administer Bactrim (Trimethoprim/Sulfamethoxazole) to cover Gram-negative and Augmentin (Amoxicillin/Clavulanate) to cover Gram-positive bacteria for a foot infection before wound sampling?

From the Guidelines

It is not recommended to give Bactria ds to cover gram-negative and Augmentin to cover gram-positive for a foot infection before sampling the wound. Ideally, wound samples should be collected before initiating antibiotic therapy to maximize the chances of identifying the causative pathogens 1. Starting antibiotics like Bactrim (sulfamethoxazole-trimethoprim) for gram-negative coverage and Augmentin (amoxicillin-clavulanate) for gram-positive coverage before sampling can reduce the sensitivity of cultures and potentially mask the true infectious agents. This can lead to incomplete or incorrect treatment.

Key Considerations

• If antibiotics must be started urgently due to severe infection, collect samples first and then immediately start empiric therapy 1.
• For diabetic foot infections or other complicated foot wounds, broad-spectrum coverage is often needed, but therapy should be tailored based on culture results 1.
• The rationale is that antibiotics quickly begin to suppress bacterial growth, which can lead to false-negative cultures or incomplete identification of all pathogens present, potentially missing resistant organisms that require specific treatment approaches.

Empiric Therapy

• Initial empiric therapy should be based on the severity of the infection and on any available microbiological data, such as recent culture results and the local prevalence of pathogens, especially antibiotic-resistant strains 1.
• The majority of mild, and many moderate, infections can be treated with agents that have a relatively narrow spectrum, usually covering only aerobic GPC 1.

Culture Collection

• Collect culture specimens only after the wound has been cleansed and debrided and prior to initiating antibiotic therapy 1.
• A sample obtained by curettage, the scraping of tissue from the ulcer base using a dermal curette or sterile scalpel blade, more accurately identifies pathogens than does rolling a swab over the wound 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Antibiotic Treatment for Foot Infections

• The provided studies do not directly address the question of using Bactria DS and Augmentin to cover gram-negative and gram-positive bacteria in foot infections before sampling the wound 2, 3, 4, 5.
• However, one study mentions the antimicrobial combination of trimethoprim and sulfamethoxazole, which is active against a variety of gram-positive and gram-negative bacteria 3.
• There is no specific information on the use of Bactria DS and Augmentin in the context of foot infections in the provided studies.
• The studies primarily focus on the analysis of absence of evidence, forensic science, and the insanity defense reform act, which are not directly relevant to the question of antibiotic treatment for foot infections 2, 4, 5.

Gram-Negative and Gram-Positive Coverage

• One study mentions that trimethoprim-sulfamethoxazole is useful for treatment and prophylaxis of various infections, including those caused by gram-positive and gram-negative bacteria 3.
• However, there is no information on the specific use of Bactria DS and Augmentin for gram-negative and gram-positive coverage in foot infections.
• The provided studies do not offer guidance on the appropriate antibiotic treatment for foot infections before sampling the wound.