Systemic antibiotics for treating diabetic foot infections

Selva, Anna; Solà, Iván; Barajas-Nava, Leticia A.; Gianneo, Oscar D; Cosp, Xavier Bonfill; Lipsky, Benjamin A.

doi:10.1002/14651858.cd009061.pub2

Cited by 58 publications

(76 citation statements)

References 75 publications

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“…We only included studies whose participants were all diabetic, not due to trauma, burns, bites or any other possible cause of foot wound infection. This is responsible for the discrepancy in included studies found between our review and the former two reviews …”

Section: Discussioncontrasting

confidence: 73%

“…A former review by Selva Olid et al (2015) exclusively included trials on systemic antibiotics. However, the diversity in design and execution of included studies hindered any potential appearance of a statistically significant effect estimate . It only recommended the use of ertapenem over tigecycline as per .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, they are generally of lower cost as compared with surgical treatment. The major disadvantages of antibiotics treatment are the development of resistant bacteria due to prolonged use and the adverse events of the drugs, such as hypersensitivity, renal impairment and digestive tract infection with Clostridium difficile bacteria …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Antibiotic therapy of diabetic foot infections: A systematic review of randomized controlled trials

Tchero¹,

Kangambega

Noubou³

et al. 2018

Wound Repair Regeneration

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Diabetic foot infection is a common diabetic complication that may end in lower limb amputation if not treated properly. We performed this systematic review to assess the clinical efficacy of different antibiotic regimens, whether systemic or topical, in the treatment of moderate to severe diabetic foot infections. We searched Medline, Web of Science, SCOPUS, Cochrane CENTRAL, and ScienceDirect for randomized controlled trials that evaluated the efficacy of antibiotic regimens in moderate to severe diabetic foot infections. The primary outcome of interest was the clinical efficacy (cure/improvement rates) of the regimens. We included 16 trials (4,158 patients) in this review, from which we extracted 10 comparisons: some trials compared systemic antibiotics to each other, others compared systemic to topical agents, while one study compared the combined topical and systemic agents to systemic antibiotics alone. Qualitative analysis of the findings of these studies showed that: (1) pipracillin/tazobactam was superior to ertapenem in severe infections (clinical resolution rate: 91.5% compared with PIP/TAZ 97.2%, p ≤ 0.04), but had similar efficacy in moderate infections, (2) ertapenem was more effective than tigecycline in moderate to severe infections (absolute difference -5.5, [95% CI -11.0, 0.1]), (3) the adjuvant use of topical agents with systemic antibiotics improved the outcomes, compared with systemic antibiotics alone (p = 0.024), (4) the rates of recurrence and re-ulceration were significantly lower in patients using the amino-penicillin regimen, compared with those using oral/intravenous ofloxacin, and (5) lower rates of complications accompanied the imipenem/cilastatin regimen, compared with the pipracillin/tazobactam regimen (p = 0.13). In conclusion, data from the included studies showed better results for ertapenem when compared with tigecycline; however, it was inferior to pipracillin/tazobactam in severe infections. The adjuvant use of topical agents improves the efficacy of systemic antibiotics in diabetic foot infection.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic therapy of diabetic foot infections: A systematic review of randomized controlled trials

Tchero¹,

Kangambega

Noubou³

et al. 2018

Wound Repair Regeneration

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“…Fourth, we decided against analysing our data based on either the specific antibiotic agents used or the role of specific pathogens (besides P. aeruginosa ). This is based on the fact that that there is no evidence that any specific systemic antibiotic regimen is significantly superior for the treatment of DFI, or for any specific pathogen . As a screening microorganism and a surrogate for a possible important and enigmatic pathogen in DFI, we chose P. aeruginosa because it is considered to be one of the most difficult microorganisms to eradicate from osteoarticular infections .…”

Section: Discussionmentioning

confidence: 99%

“…Because of the potential for poor outcomes of these DFIs, many clinicians choose a longer duration of antibiotic therapy than guidelines recommend, which can result in drug‐related adverse effects and costs, and the development of antibiotic resistance . Despite substantial variation in clinical practice, most studies that have investigated the choice of antimicrobial agents for DFIs have compared different regimens, rather than outcomes related to treatment duration . Although data on the appropriate duration of therapy for DFIs are scarce, expert guidance suggests that 1 to 3 weeks is sufficient for most soft tissue infections, and 4 to 6 weeks is adequate for those associated with osteomyelitis, especially without surgical management .…”

Section: Introductionmentioning

confidence: 99%

Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors

Gariani

Lebowitz

Dach

et al. 2018

Diabetes Obesity Metabolism

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Topical antimicrobial agents for treating foot ulcers in people with diabetes

Dumville

Lipsky

Hoey

et al. 2017

Cochrane Database of Systematic Reviews

101

121

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The randomised controlled trial data on the effectiveness and safety of topical antimicrobial treatments for diabetic foot ulcers is limited by the availability of relatively few, mostly small, and often poorly designed trials. Based on our systematic review and analysis of the literature, we suggest that: 1) use of an antimicrobial dressing instead of a non-antimicrobial dressing may increase the number of diabetic foot ulcers healed over a medium-term follow-up period (low-certainty evidence); and 2) there is probably little difference in the risk of adverse events related to treatment between systemic antibiotics and topical antimicrobial treatments based on the available studies (moderate-certainty evidence). For each of the other outcomes we examined there were either no reported data or the available data left us uncertain as to whether or not there were any differences between the compared treatments. Given the high, and increasing, frequency of diabetic foot wounds, we encourage investigators to undertake properly designed randomised controlled trials in this area to evaluate the effects of topical antimicrobial treatments for both the prevention and the treatment of infection in these wounds and ultimately the effects on wound healing.

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Systemic antibiotics for treating diabetic foot infections

Cited by 58 publications

References 75 publications

Antibiotic therapy of diabetic foot infections: A systematic review of randomized controlled trials

Antibiotic therapy of diabetic foot infections: A systematic review of randomized controlled trials

Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors

Topical antimicrobial agents for treating foot ulcers in people with diabetes

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