Is oral amoxicillin/clavulanate effective for diabetic foot infections?

  • Gariani K & al.
  • Diabetes Obes Metab
  • 5 Feb 2019

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Oral amoxicillin/clavulanate (AMC) is a reasonable option for treating patients with diabetic foot infections (DFI) and diabetic foot osteomyelitis (DFO).

Why this matters

  • Some clinicians avoid oral AMC for treating DFI and especially DFO because of poor bioavailability and bone penetration of all β-lactam antibiotics.

Study design

  • Retrospective cohort analysis of 794 DFI episodes in 419 patients, including 339 DFO cases.
  • Funding: Geneva University Hospitals.

Key results

  • Most frequent pathogens were
    • Staphylococcus aureus (n=273; 61 methicillin-resistant),
    • streptococci (121), and
    • gram-negative (269).
  • In median 30-days postsurgical treatment, β-lactams were used in 631 DFI episodes, including oral AMC in 301 cases; others included quinolones (204), glycopeptides (120), and clindamycin (84).
  • At median 7.5 months posttherapy, outcomes with oral AMC therapy did not differ from other agents overall, including for DFOs.
  • Oral AMC led to 74% remission (131/178) vs 79% (485/616) in non-β-lactam regimens (P=.15).
  • Corresponding incidences for the DFO subset were 82.4% (215/261) vs 80% (60/75), respectively.
  • After adjustment, oral AMC achieved the same remission, either when administered from the start (HR, 0.9; 95% CI, 0.5-1.6) or when calculated as absolute numbers of treatment days (HR, 1.0; 95% CI, 0.9-1.1), with consistent results for DFOs.

Limitations

  • Retrospective, single-center.

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