Investigation

1. Is there Osteomyolytis? → Affect the duration of the therapy

   • 2x2 cm, 3 cm deep

   • Probe to bone (most helpful)
2. Ideally, obtain sterile culture (in SB patient)

Treatment

Prevention

• Foot Care

Empiric Abx

Mild or relatively “untreated” ulcers

• Cefazolin (1 gen IV) 1-2g IV tid or Cephalexin (1 gen PO) 500mg PO qid
  • Duration 5-14 days*

Severe or chronic ulcers

• CTX - Ceftriaxone (3 gen IV) 1g IV daily + Metronidazole 500mg IV/PO bid
• Pip/Tazo (Tazocin) 4.5g IV tid +/- Vancomycin IV
• Consider a carbapenem if colonised with resistant GNB

In addition to antibiotics

• Wound care
• +/- surgical debridement
• +/- revascularization