Diabetic Foot Syndromes: Antibiotics At A Crossroads

Dr Kinjal Patel
10 Oct, 2025
Diabetic foot syndromes are characterised by a number of different types of tissue involvement and infection, each linked to particular pathogens and treatment outcomes. Clinical outcomes are influenced by the severity of the infection, the organisms causing it and the comorbidities of the patient. Common forms include gangrene, osteomyelitis, soft tissue infections and skin ulcers. 
Most infections are polymicrobial, with aerobic gram-positive cocci (GPC) and especially Staphylococci. In persistent infections or infections that occur after antibiotic therapy, aerobic gram-negative bacilli are often copathogens and obligate anaerobes can be copathogens in wounds that are ischaemic or necrotic. 
Osteomyelitis and necrotic infections are more difficult to treat and have a lower success rate than skin ulcers and mild infections. And the use of antibiotics is not necessary for wounds that show no signs of soft tissue or bone infection. In many patients with acute infections, empiric antibiotic therapy can be specifically directed towards GPC, but, patients with chronic, previously treated, or severe illnesses, or those at risk of infection with organisms resistant to antibiotics, typically need broader range regimens. When matched to bacterial sensitivities and infection severity, ceftaroline, dalbavancin, meropenem, piperacillin-tazobactam, amikacin, gentamicin, tobramycin and levofloxacin are the antibiotics that have the best success rates in treating diabetic foot infections.
Currently, one of the biggest challenges is rising resistance, which highlights the necessity of tailored treatment. When choosing antibiotics to treat patients, physician should take into account the previous drug responses, local antimicrobial sensitivities, infection severity and patient variables. It is still unclear if any one antibiotic is superior for resolving an infection or safer than other antibiotics. 
For people with diabetes, foot infections are a common and dangerous issue. Antibiotics will therefore constantly be in a state of confusion when it comes to treating these infections.


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References

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Dr Kinjal Patel

Dr Kinjal Patel

Medical Microbiologist with an aptitude for holistic wellness and serving community with so far acquired knowledge. A dedicated reader in pursuit of improving human lives by transforming laboratory medicine and sharing pearls of medicine. Her life's mantra is "do what you love or love what you do".

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