Contiguous, Vascular insufficiency, diabetic foot
- Tetanus prophylaxis recommended.
- Bone biopsy for histology and culture recommended if attainable.
- Anaerobic coverage recommended if:
- severe ischemia
- foul-smelling discharge
- necrosis
- gangrene
- Switch to oral therapy should be guided by clinical improvement and deep tissue culture and susceptibility results.
- Monitor renal function and adjust dosing of antibiotics according to renal function.
Usual Pathogens
Polymicrobial:
S. aureus/MRSA
Streptococcus spp
Enterococcus spp
Enterobacterales
P. aeruginosa
Anaerobes
Candida spp
Mild-moderate
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO tid | 3-6 weeks |
| or | ||
| [Cefazolin | 2g IV q8h | 3-6 weeks |
| +/- | ||
| Metronidazole] | 500mg PO tid |
If MRSA suspected
| Empiric Therapy | Duration | |
|---|---|---|
| Add to regimens above: | ||
| TMP/SMX | 2DS tabs PO bid | 3-6 weeks |
| or | ||
| Doxycycline | 100mg PO bid | 3-6 weeks |
Outpatient and failure of oral therapy
| Empiric Therapy | Duration | |
|---|---|---|
| Ceftriaxone | 2g IV daily | 3-6 weeks |
| +/- | ||
| Metronidazole IV/PO | 500mg PO/IV q8h |
Outpatient and past/current ceftriaxone-resistant Enterobacterales
| Empiric Therapy | Duration | |
|---|---|---|
| Ertapenem | 1g IV daily | 3-6 weeks |
Moderate-severe
| Empiric Therapy | Duration | |
|---|---|---|
| [Vancomycin | 15mg/kg IV q12h | 3-6 weeks |
| + | ||
| Ceftriaxone | 1-2g IV daily | |
| + | ||
| Metronidazole IV/PO] | 500mg PO/IV q8h | |
| or | ||
| Amoxicillin-clavulanate | 1.2g IV q6h | 3-6 weeks |
Severe/Limb threatening
| Empiric Therapy | Duration | |
|---|---|---|
| Piperacillin-tazobactam | 3.375g IV q6h | 3-6 weeks |
| + | ||
| Vancomycin | 15mg/kg IV q12h | |
| Past/current ceftriaxone-resistant Enterobacterales or recent piperacillin-tazobactam use | ||
| Meropenem | 500mg IV q6h | 3-6 weeks |
| + | ||
| 15mg/kg IV q12h | ||