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DER 1.04 Bacterial: diabetic foot and peripheral arterial disease

Content version
U-104.2
Updated
10/20/2025 - 14:36

Recommendations

≥ 18 years

Indications: IWGDF classification Mild: classic signs of infection, <2 cm erythema, skin/subcutaneous tissue involvement
Dosage Remarks
1st choice
flucloxacillin oral 1000 mg 4 times daily 10 to 14 days
2nd choice
clindamycin oral 600 mg 3 times daily 10 to 14 days
≥ 18 years

Indications: IWGDF classification Moderate: local infection, erythema >2 cm or involvement of deeper structures
Dosage Remarks
1st choice
amoxicillin + clavulanic acid oral 875/125 mg 3 times daily 10 to 14 days
2nd choice
ciprofloxacin oral 750 mg 2 times daily 10 to 14 days

+

clindamycin oral 600 mg 3 times daily 10 to 14 days
≥ 18 years

Indications: IWGDF classification Severe: local infection + systemic manifestations
Dosage Remarks
1st choice
piperacillin/tazobactam IV 4000/500 mg 4 times daily

If clinical improvement occurs switch to oral therapy. Duration up to 6 weeks for osteomyelitis.
2nd choice
teicoplanin IV once daily

+

ceftazidime IV 2000 mg 3 times daily

If clinical improvement occurs switch to oral therapy. Duration up to 6 weeks for osteomyelitis.

See dosing of teicoplanin

Comments

Obtain a tissue specimen to identify the causative pathogen of a foot infection. Preferably obtain a biopsy for tissue culture; if this is not possible, obtain material from the wound bed for a deep wound culture. Preferably avoid using a superficial wound swab to identify the pathogen of a foot infection.

To determine the causative microorganism of osteomyelitis:

  • Preferably a percutaneous bone biopsy. 
  • Only if a percutaneous bone biopsy is not possible, take a biopsy from the base of the ulcer. 
  • Only if a percutaneous bone biopsy and biopsy from the base of the ulcer are not possible, take a deep culture using a swab from the ulcer base.

Treat osteomyelitis with antibiotics for six weeks if no surgery is performed, and for one to two weeks if all infected bone has been removed.