These guidelines were developed and issued on behalf of the Infectious Diseases Society of America. a B.A.L. served as the chairman and A.R.B. served as the vice chairman of the Infectious Diseases Society of America Guidelines Committee on Diabetic Foot Infections.b Deceased.

Foot infections in diabetic patients are predominantly caused by gram-positive cocci, many of which are now antibiotic resistant. Because linezolid is active against these pathogens, we compared the efficacy and safety of intravenous and oral formulations with that of intravenous ampicillin-sulbactam and intravenous and oral amoxicillin-clavulanate given for 7-28 days in a randomized, open-label, multicenter study of all types of foot infection in diabetic patients (ratio of linezolid to comparator drug recipients, 2:1). Among 371 patients, the clinical cure rates associated with linezolid and the comparators were statistically equivalent overall (81% vs. 71%, respectively) but were significantly higher for linezolid-treated patients with infected foot ulcers (81% vs. 68%; P=.018) and for patients without osteomyelitis (87% vs. 72%; P=.003). Cure rates were comparable for inpatients and outpatients and for both oral and intravenous formulations. Drug-related adverse events were significantly more common in the linezolid group, but they were generally mild and reversible. Linezolid was at least as effective as aminopenicillin/beta-lactamase inhibitors for treating foot infections in diabetic patients.

No abstract

The methods and criteria for testing for synergy were compared with use of 22 strains of Klebsiella pneumoniae and a combination of cephalothin and gentamicin. With the checkerboard technique, the frequency of synergy varied depending on the criterion employed. When the rate of killing of bacteria by antibiotics was measured, results varied depending on the size of inoculum. When the checkerboard and killing-curve techniques were compared, there was poor correlation in terms of the frequency of strains showing synergy. Because clinical observations suggest that treatment of serious infections with combinations of antibiotics found to be synergistic in vitro may enhance survival, standardization of the methods and criteria used to test for synergy should be undertaken.