Short and oral antimicrobial therapy for diabetic foot infection: anarrative review of current knowledge

Diabetic foot infection is a frequent complication in long-standingdiabetes mellitus. For antimicrobial therapy of this infection, both theoptimal duration and the route of administration are often based more onexpert opinion than on published evidence. We reviewed the scientificliterature, specifically seeking prospective trials, and aimed at addressingtwo clinical issues: (1) shortening the currently recommended antibioticduration and (2) using oral (rather than parenteral) therapy, especiallyafter the patient has undergone debridement and revascularization. We alsoreviewed some older key articles that are critical to our understanding of thetreatment of these infections, particularly with respect to diabetic foot osteomyelitis.Our conclusion is that the maximum duration of antibiotic therapy forosteomyelitis should be no more than to 4-6 weeks and might even be shorterin selected cases. In the future, in addition to conducting randomized trials and propagating national and international guidance, we should also exploreinnovative strategies, such as intraosseous antibiotic agents andbacteriophages.