Oral Amoxicillin/Clavulanate for Treating Diabetic Foot Infections.

Gariani, Karim; Lebowitz, Dan; Kressmann, Benjamin; von Dach, Elodie; Sendi, Parham; Waibel, Felix; Berli, Martin; Huber, Tanja; Lipsky, Benjamin A; Uçkay, Ilker (2019). Oral Amoxicillin/Clavulanate for Treating Diabetic Foot Infections. Diabetes, obesity & metabolism, 21(6), pp. 1483-1486. Wiley 10.1111/dom.13651

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Some clinicians avoid amoxicillin-clavulanate (AMC) for the oral therapy of diabetic foot infections (DFI), especially for osteomyelitis (DFO), due to its poor bioavailability and bone penetration of all antibiotics from the β-lactam class. We performed a retrospective cohort analysis among 794 DFI episodes, including 339 DFO cases. The median duration of antibiotic therapy after surgical debridement (including partial amputation) was 30 days (DFO 30 days). Oral AMC was prescribed for a median of 20 days (interquartile range, 12-30 d). The median ratio of oral AMC among the entire antibiotic treatment was 0.9 (interquartile range, 0.7-1.0). After a median follow-up of 3.3 years, 178 DFIs (22%) overall recurred (DFO 75; 22%). Overall, oral AMC led to 74% remission compared to 79% with other regimens (χ -test; p=0.15). In multivariate analyses and stratified subgroup analyses, oral AMC resulted in similar clinical outcomes to other antimicrobial regimens; either when used orally from the start, after an initial parenteral therapy, or when prescribed for DFOs. We conclude that oral AMC is a reasonable option when treating patients with DFIs and DFOs. This article is protected by copyright. All rights reserved.

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