Abstract. Diabetic foot infection is a frequent complication in long-standing
diabetes mellitus. For antimicrobial therapy of this infection, both the
optimal duration and the route of administration are often based more on
expert opinion than on published evidence. We reviewed the scientific
literature, specifically seeking prospective trials, and aimed at addressing
two clinical issues: (1) shortening the currently recommended antibiotic
duration and (2) using oral (rather than parenteral) therapy, especially
after the patient has undergone debridement and revascularization. We also
reviewed some older key articles that are critical to our understanding of the
treatment of these infections, particularly with respect to diabetic foot osteomyelitis.
Our conclusion is that the maximum duration of antibiotic therapy for
osteomyelitis should be no more than to 4–6 weeks and might even be shorter
in selected cases. In the future, in addition to conducting randomized trials and propagating national and international guidance, we should also explore
innovative strategies, such as intraosseous antibiotic agents and
bacteriophages.
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