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