Advances in Antibiotics for Diabetic Foot Ulcers Are Still needed

“Treatment of diabetic foot ulcers depends upon the severity of the infection,” said Andrew Boulton, MD, University of Manchester, UK, University of Miami, Florida at AACE 2017.

Boulton referred to the Infectious Disease Society of America guidelines last published 4 years ago (the members are currently working on a revision) as an excellent approach to treating mild, moderate, or severe infections. The most important thing to remember, according to Boulton, is that for patients who don’t have clinical signs of infection, there is no evidence that antibiotics are any good at all. It’s what you take off the wound that matters.

Typically, doctors start with broad-spectrum antibiotics for mildly to moderately affected ulcers. Boulton stressed; however, that despite how popular, a wound swab is a waste of time, because “you’ll grow many organisms that we all have on our feet, and one doesn’t know if these are relevant to the infection.”

While diabetic neuropathy and peripheral vascular disease are more common with increasing and increasing duration of diabetes, some doctors are seeing many young people with some evidence of neuropathy. Fortunately, though, foot ulcers are extremely rare in patients under mid-20s, because diabetic neuropathy is due to glycemic control and duration of disease.

Boulton has been impressed with the technology of the 21^st century, specifically a bathmat that is actually a foot sensor that is connected electronically to a central reader. The idea is for patients to stand on it each morning and self-monitor skin temperatures. If they find one foot is warmer than the other, the podiatrist or nurse or healthcare provider in the office would call that patient and he or she can immediately stop walking and take rest. This intervention has been shown to reduce significantly ulcers compared to the group that just had standard education alone.