Page 45 - HPP ANTIMICROBIAL GUIDELINE 2018
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Suggested Treatment
Infection/ Condition Comments
Preferred Alternative
Diabetic Foot Infections
Antibiotics should not be used unless there are local or systemic symptoms of infection. Surgical debridement is important. Antibiotic selection should be
based on the most recent culture and sensitivity report.
Mild Infections: Amoxicillin/clavulanate 625mg PO Cephalexin 500 mg PO q8H Duration: 5 to 7 days
a. Local infection involving skin & q8hrly
subcutaneous tissue PLUS
b. Erythema, less than 2 cm around the OR Metronidazole 400 mg PO q8H
ulcer Ampicillin/sulbactam
c. No systemic signs of infection 375mg-750mg PO q12hrly
Moderate Infections: Duration: 7 to 14 days
a. Deep tissue infection Ampicillin/sulbactam 3gm IV q6h Cefazolin 2gmIV q 8hrly Modify according to clinical response
b. Erythema more than 2 cm around ulcer
c. No SEPSIS criteria PLUS
Metronidazole 500mg IV q8h If proven osteomyelitis or margin of
resection is inadequate : at least 4-6
weeks
However, a shorter duration
(1 to 2 weeks) is sufficient if margin
of surgical resection is adequate
Severe Infections:
All of the above PLUS Piperacillin/tazobactam 4.5gm IV Cefepime 2 gm IV 8hrly
2 or more SIRS q6-8h
Plus
URGENT Surgical debridement Metronidazole 500mg IV q8hrly
HPP AMG Bone & Joints Infections 17
