First-line antibiotics for diabetic foot ulcers

What are the first-line antibiotics for the treatment of diabetic foot ulcers?

Andrew Boulton: First of all, I can tell you that not all diabetic foot ulcers require antibiotic treatment. Indeed, if there is no clinical evidence for infection – there was one of the very few randomized controlled trials that showed that if there is no clinical infection, you did just as well without an antibiotic as with one.

If you got a clinically infected ulcer, to be quite honest there are no randomized controlled trials to tell us which to use first. I would normally start with something broad-spectrum, such as co-amoxiclav, or Augmentin, or clindamycin, which has good bone penetration. Then, when you have got results of tissue specimens, a wound swab is a waste of time – you need to debride the wound and get a deep-tissue specimen to the laboratory. That can help guide to target the organism that is likely the infecting one.