Infectious Diseases in Critical Care Medicine

Table 3

Antimicrobial Therapy and Microbiology Associated with Diabetic Foot Infection and Necrotizing Fasciitis

Clinical syndrome

Pathogen

Recommended therapy

Optional therapy

Diabetic foot

infection

S. aureus

,

Streptococcus,

Enterobacteriaceae,P. aeruginosa

anaerobes

(Bacteroides,Peptostreptococcus

)

Ampicillin/sulbactam 1.5–3 g IV every 6 hr or

piperacillin/tazobactam 3.75–4.5 g IV q.i.d. orceftriaxone 1–2 g IV every 24 hr

þ

metronidazole

500 mg IV every 8 hr

a

Carbapenem (imipenem/cilastatin 500 mg–1 g IV

every 6–8 hr or meropenem 1 g IV every orertapenem 1 g IV every 24 hr or doripenem500 mg IV every 8 hr) or clindamycin 600–900 mgIV every 8 hr

þ

ciprofloxacin (500–750 mg PO or

400 mg IV every 12 hr) or cefepime 1–2 gm IVevery 8–12 hr

þ

metronidazole 500 mg IV or PO

every 8 hr

Type 1 NF

Anaerobes (

Bacteroides,

Peptostreptococcus

)

E. coli,

Enterobacteriaceae, Klebsiella,Proteus, S. aureus

Vancomycin 15 mg/kg IV every 12 hr

b

þ

ampicillin/

sulbactam 1.5–3 gm IV every 6 hr or piperacillin/tazobactam 3.75–4.5 g IV every 6 hr

þ

clindamycin

900 mg IV every 8 hr



ciprofloxacin 400 mg IV every

12 hr or Ceftriaxone 1–2 g IV every 24 hr

þ

metronidazole 500 mg IV every 6–8 hr

Carbapenem (imipenem/cilastatin 500 mg–1 g IV

every 6–8 hr or meropenem 1 g IV every orertapenem 1 g IV every 24 hr or doripenem 500mg IV every 8 hr) or clindamycin 900 mg IV every8hr

þ

gentamicin or tobramycin 5 mg

c

or

ciprofloxacin

Type 2 NF

Group A

Streptococcus

Penicillin 2–4 mu IV every 4–6 hr

þ

clindamycin 900 mg

IV every 8 hr,



IVIG

cefazolin 1–2 g every 8 hr or vancomycin 15 mg/kg

IV q 12 hr

þ

clindamycin 900 mg IV every 8 hr

S. aureus

(MRSA)

Vancomycin 15 mg/kg IV every 12 hr

þ

dClindamycin

900 mg IV every 8 hr

Daptomycin 4–6 mg/kg IV every 24 hr or linezolid

600 mg IV every 12 hr or tigecycline 100 mg IVthen 50 mg every 12 hr telavancin 10 mg/kg IVevery 24 hr

MSSA

Nafcillin 1–2 gm IV every 4 hr or cefazolin 1–2 g IV

every 8 hr

þ

clindamycin 900 mg IV every 8 hr

Vancomycin or linezolid or daptomycin or tigecycline

or telavancin

Clostridium

infection

Penicillin 2–4 mu IV every 4–6 hr

þ

clindamycin 900 mg

IV every 8 hr

Dose adjusted for azotemia except for ceftriaxone, clindamycin and linezolid.aWhen MRSA suspected use vancomycin, linezolid, daptomycin, or other active agents.bCoverage should include MRSA infection till excluded.cBased on once a day dose of 5.0 mg/kg/day, however can be given as 1.7 mg/kg IV t.i.d.dClindamycin or linezolid is recommended because of ability to inhibit toxin production.Abbreviation

: mu, million unit.

306 Sharma and Saravolatz