Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review

Laura Soldevila-Boixader; Alberto Pérez Fernández; Javier Muñoz Laguna; Ilker Uçkay

doi:10.3390/antibiotics12010124

Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review

Antibiotics (Basel). 2023 Jan 9;12(1):124. doi: 10.3390/antibiotics12010124.

Authors

Laura Soldevila-Boixader^{1

2}, Alberto Pérez Fernández³, Javier Muñoz Laguna^{4

5}, Ilker Uçkay¹

Affiliations

¹ Infectiology, Unit for Applied and Clinical Research, Balgrist University Hospital, 8008 Zurich, Switzerland.
² Infectious Diseases Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain.
³ Orthopedics Department, Head of the Foot and Ankle Unit and Coordinator of Diabetic Foot Unit, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain.
⁴ EBPI-UZWH Musculoskeletal Epidemiology Research Group, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland.
⁵ University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland.

Abstract

Along with the increasing global burden of diabetes, diabetic foot infections (DFI) and diabetic foot osteomyelitis (DFO) remain major challenges for patients and society. Despite progress in the development of prominent international guidelines, the optimal medical treatment for DFI and DFO remains unclear as to whether local antibiotics, that is, topical agents and local delivery systems, should be used alone or concomitant to conventional systemic antibiotics. To better inform clinicians in this evolving field, we performed a narrative review and summarized key relevant observational studies and clinical trials of non-prophylactic local antibiotics for the treatment of DFI and DFO, both alone and in combination with systemic antibiotics. We searched PubMed for studies published between January 2000 and October 2022, identified 388 potentially eligible records, and included 19 studies. Our findings highlight that evidence for adding local antibiotic delivery systems to standard DFO treatment remains limited. Furthermore, we found that so far, local antibiotic interventions have mainly targeted forefoot DFO, although there is marked variation in the design of the included studies. Suggestive evidence emerging from observational studies underscores that the addition of local agents to conventional systemic antibiotics might help to shorten the clinical healing time and overall recovery rates in infected diabetic foot ulcers, although the effectiveness of local antibiotics as a standalone approach remains overlooked. In conclusion, despite the heterogeneous body of evidence, the possibility that the addition of local antibiotics to conventional systemic treatment may improve outcomes in DFI and DFO cannot be ruled out. Antibiotic stewardship principles call for further research to elucidate the potential benefits of local antibiotics alone and in combination with conventional systemic antibiotics for the treatment of DFI and DFO.

Keywords: diabetic foot infection; local antibiotics; local delivery antibiotic systems; osteomyelitis; topical antibiotics.

Publication types

Review

Grants and funding

L.S.-B. was supported with a grant of the Ministerio de Ciencia, Innovación y Universidades (FPU (18/02768)) and by a mobility grant provided from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). J.M.L. reports funding from the European Cooperation in Science and Technology (COST) outside of the submitted work.