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Journal of the American Podiatric Medical Association
Volume 100 Number 1 52-63 2010
Copyright © 2010 American Podiatric Medical Association

Therapeutic Options for Diabetic Foot Infections

A Review with an Emphasis on Tissue Penetration Characteristics

David P. Nicolau, PharmD * and Gary E. Stein, PharmD {dagger}

* Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT.
{dagger} Department of Medicine, Michigan State University, East Lansing, MI.

Corresponding author: David P. Nicolau, PharmD, Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour St, Hartford, CT 06102-5037. (E-mail: dnicola{at}harthosp.org)

Abstract

Foot complications are common in diabetic patients; foot ulcers are among the more serious consequences. These ulcers frequently become infected, and if not treated promptly and appropriately, diabetic foot infections can lead to septic gangrene and amputation. Foot infections may be classified as mild, moderate, or severe; this largely determines the approach to therapy. Staphylococcus aureus is the most common pathogen in these infections, and the increasing incidence of methicillin-resistant S aureus during the past two decades has further complicated antibiotic treatment. Chronic infections are often polymicrobial. Physiologic changes, and local and systemic inflammation, can affect the plasma and tissue pharmacokinetics of antimicrobial agents in diabetic patients, leading to impaired target-site penetration. Knowledge of the serum and tissue concentrations of antibiotics in diabetic patients is, therefore, important for choosing the optimal drug and dose. This article reviews the commonly used therapeutic options for treatment, including many newer antibiotics developed to target multidrug-resistant gram-positive bacteria, and includes available data relating specifically to the tissue penetration of these agents. (J Am Podiatr Med Assoc 100(1): 52–63, 2010)






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