How to manage a diabetic foot ulcer?

Question

Hello doctor,

I am a 48-year-old male weighing 202 lbs and I have a diabetic foot ulcer on my left foot with an infection on the ankle bone and joint. Currently, I am taking a 10 ml insulin dose in the morning and the evening Vancomycin antibiotics two tablets four times daily, and Cecloxib 200 mg. Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

It seems you have a severe diabetic foot infection involving deep tissues and likely bone. You would need wound swab culture and sensitivity. Escalation of antibiotics further as per the culture and sensitivity. Additional antibiotics as per the allergy information and renal function would be required, but I would recommend that the treating doctor consider the following as inpatient treatment-

1. Only suitable for patients with adequate renal function.

Flucloxacillin IV 1 to 2 g- four times a day. With or without Gentamicin IV once a day (use dose calculator, maximum daily dose 560 mg; maximum five days Gentamicin unless on microbiology advice; use dosing and monitoring guide and check levels).

Or

Metronidazole IV 500 mg three times a day (if anaerobes are suspected).

2. If there is significant renal impairment:

Ceftriaxone IV 2 g once daily with Metronidazole IV 500 mg three times a day.

3. If Pseudomonas is suspected or confirmed:

Piperacillin-Tazobactam IV 4.5 g four times a day.

4. If MRSA (Methicillin-resistant staphylococcus aureus) is suspected or confirmed:

Vancomycin IV (see local Vancomycin guidelines, monitor levels)

You would need daily dressing and adequate blood sugar monitoring, definitely as an inpatient.

I hope that you get your answer.

Please, let me know if you want some help.

Thank you.