Diabetic foot infections: an audit of antibiotic prescribing in a diabetic foot clinic

Infected diabetic foot ulcers cause substantial morbidity and mortality. Antibiotic therapy is necessary for all infected ulcers but widespread antibiotic prescription can lead to adverse effects and increased resistance. The main purpose of this audit was to survey our antibiotic prescription pattern and to assess the appropriateness of prescriptions in the diabetic foot clinic. We graded 85 consecutive wounds seen in the clinic using the University of Texas Wound Classification System (UTWCS). This system allows ulcers to be classified according to depth, presence of infection and ischaemia. We found that 55 wounds (65%) were infected and antibiotics were prescribed for 51 wounds (93%). Four infected wounds did not have antibiotics prescribed. Four patients (7%) with infected ulcers required admission for intravenous antibiotic treatment. All four had deep infections involving bone. Deep wound swabs were performed on 52 of the infected wounds and three (6%) grew methicillin‐resistant Staphylococcus aureus. The antibiotics commonly used were cefradine, clindamycin, and combinations of clindamycin + ciprofloxacin or amoxicillin + flucloxacillin. In the remaining 30 uninfected wounds (35%), no antibiotics were prescribed. In the foot clinic, antibiotic prescription was generally appropriate but not all patients with infected ulcers received antibiotic therapy. As a result of this audit, we have devised a simple antibiotic protocol in an attempt to improve the management of infected diabetic wounds in a safe, methodical and effective manner. Copyright © 2006 John Wiley & Sons.