Clinical efficacy, tolerability, and cost savings associated with the use of open-label metronidazole plus ceftriaxone once daily compared with ticarcillin/clavulanate every 6 hours as empiric treatment for diabetic lower-extremity infections in older males

Clay, Patrick G.; Graham, Maqual R.; Lindsey, Cameron C.; Lamp, Kenneth C.; Freeman, Collin D.; Glaros, Alan G.

doi:10.1016/j.amjopharm.2004.09.006

Cited by 34 publications

(35 citation statements)

References 26 publications

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“…Numerous trials of antibiotic therapy have been conducted to evaluate different regimens (Table III). [68][69][70][71][72][73] The Study of Infections in Diabetic Feet Comparing Efficacy, Safety, and Tolerability of Ertapenem Versus Piperacillin/Tazobactam (SIDESTEP) is the largest and most recent randomized, multicenter study. It evaluated onetime-daily ertapenem vs four-times-daily piperacillin/ tazobactam in moderate and severe diabetic foot infections.…”

Section: Medical Treatmentsmentioning

confidence: 99%

Management of diabetic foot problems

Kalish

Hamdan

2010

Journal of Vascular Surgery

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Section: Medical Treatmentsmentioning

confidence: 99%

Management of diabetic foot problems

Kalish

Hamdan

2010

Journal of Vascular Surgery

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“…We identified 106 references in total (86 by electronic literature search and 20 by manual screening). Finally, 16 trials (4158 participants) were included in this systematic review . We also identified one ongoing trial in the trial registers; however, it was unclear whether it met the inclusion criteria of our review .…”

Section: Resultsmentioning

confidence: 99%

“…This practice is still widely adopted because no firm evidence has yet been produced for a better protocol. However, other factors, such as cost‐effectiveness and safety may affect the treatment decision …”

Section: Introductionmentioning

confidence: 99%

Antibiotic therapy of diabetic foot infections: A systematic review of randomized controlled trials

Tchero¹,

Kangambega

Noubou³

et al. 2018

Wound Repair Regeneration

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Diabetic foot infection is a common diabetic complication that may end in lower limb amputation if not treated properly. We performed this systematic review to assess the clinical efficacy of different antibiotic regimens, whether systemic or topical, in the treatment of moderate to severe diabetic foot infections. We searched Medline, Web of Science, SCOPUS, Cochrane CENTRAL, and ScienceDirect for randomized controlled trials that evaluated the efficacy of antibiotic regimens in moderate to severe diabetic foot infections. The primary outcome of interest was the clinical efficacy (cure/improvement rates) of the regimens. We included 16 trials (4,158 patients) in this review, from which we extracted 10 comparisons: some trials compared systemic antibiotics to each other, others compared systemic to topical agents, while one study compared the combined topical and systemic agents to systemic antibiotics alone. Qualitative analysis of the findings of these studies showed that: (1) pipracillin/tazobactam was superior to ertapenem in severe infections (clinical resolution rate: 91.5% compared with PIP/TAZ 97.2%, p ≤ 0.04), but had similar efficacy in moderate infections, (2) ertapenem was more effective than tigecycline in moderate to severe infections (absolute difference -5.5, [95% CI -11.0, 0.1]), (3) the adjuvant use of topical agents with systemic antibiotics improved the outcomes, compared with systemic antibiotics alone (p = 0.024), (4) the rates of recurrence and re-ulceration were significantly lower in patients using the amino-penicillin regimen, compared with those using oral/intravenous ofloxacin, and (5) lower rates of complications accompanied the imipenem/cilastatin regimen, compared with the pipracillin/tazobactam regimen (p = 0.13). In conclusion, data from the included studies showed better results for ertapenem when compared with tigecycline; however, it was inferior to pipracillin/tazobactam in severe infections. The adjuvant use of topical agents improves the efficacy of systemic antibiotics in diabetic foot infection.

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“…In these circumstances, ceftriaxone may be given intramuscularly together with metronidazole orally. Ceftriaxone has been demonstrated to be just as efficacious as ticarcillin/clavulanate 25. However, where the cellulitis is extensive, or in the ischemic foot, intravenous antibiotics and hospital admission will be needed at the outset for patients with spreading infection.…”

Section: Treatmentmentioning

confidence: 99%

The treatment of diabetic foot infections: focus on ertapenem

Edmonds¹

2009

VHRM

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Clinically, 3 distinct stages of diabetic foot infection may be recognized: localized infection, spreading infection and severe infection. Each of these presentations may be complicated by osteomyelitis. Infection can be caused by Gram-positive aerobic, and Gram-negative aerobic and anaerobic bacteria, singly or in combination. The underlying principles are to diagnose infection, culture the bacteria responsible and treat aggressively with antibiotic therapy. Localized infections with limited cellulitis can generally be treated with oral antibiotics on an outpatient basis. Spreading infection should be treated with systemic antibiotics. Severe deep infections need urgent admission to hospital for wide-spectrum intravenous antibiotics. Clinical and microbiological response rates have been similar in trials of various antibiotics and no single agent or combination has emerged as most effective. Recently, clinical and microbiological outcomes for patients treated with ertapenem were equivalent to those for patients treated with piperacillin/tazobactam. It is also important to judge the need for debridement and surgery, to assess the arterial supply to the foot and consider revascularization either by angioplasty or bypass if the foot is ischemic. It is also important to achieve metabolic control. Thus infection in the diabetic foot needs full multidisciplinary treatment.

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Clinical efficacy, tolerability, and cost savings associated with the use of open-label metronidazole plus ceftriaxone once daily compared with ticarcillin/clavulanate every 6 hours as empiric treatment for diabetic lower-extremity infections in older males

Cited by 34 publications

References 26 publications

Management of diabetic foot problems

Management of diabetic foot problems

Antibiotic therapy of diabetic foot infections: A systematic review of randomized controlled trials

The treatment of diabetic foot infections: focus on ertapenem

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