Comparison of efficacy of systemic antibiotics alone and combination of systemic antibiotics with gentamicin cream in diabetic foot infections

Memon, Munawer Latif; Ikram, Muhammad; Azhar, Muhammad; Balouch, Varda

doi:10.12669/pjms.38.3.3277

Cited by 3 publications

(7 citation statements)

References 20 publications

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“…Studies that have addressed the potential benefit of topical administration of antibiotics as adjunctive treatment to systemic antibiotic therapy for soft-tissue DFIs have provided conflicting results. [166][167][168][169][170][171][172] Limited data from studies with high-risk of bias suggest a potential benefit of antibiotic-loaded cement and intraoperative site vancomycin powder application in patients with DFO treated by surgical debridement. [173][174][175][176] Overall, these studies, characterised by a potentially high risk of bias, inconsistency, imprecision and low certainty, do not demonstrate a significant clinical benefit of topical antibiotics in the treatment of either diabetes-related foot soft tissue or bone infections.…”

Section: Rationalementioning

confidence: 99%

IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes‐related foot infections (IWGDF/IDSA 2023)

Senneville,

Albalawi,

van Asten

et al. 2023

Diabetes Metabolism Res

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the management and prevention of diabetes‐related foot diseases since 1999. The present guideline is an update of the 2019 IWGDF guideline on the diagnosis and management of foot infections in persons with diabetes mellitus.The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was used for the development of this guideline. This was structured around identifying clinically relevant questions in the P(A)ICO format, determining patient‐important outcomes, systematically reviewing the evidence, assessing the certainty of the evidence, and finally moving from evidence to the recommendation. This guideline was developed for healthcare professionals involved in diabetes‐related foot care to inform clinical care around patient‐important outcomes. Two systematic reviews from 2019 were updated to inform this guideline, and a total of 149 studies (62 new) meeting inclusion criteria were identified from the updated search and incorporated in this guideline. Updated recommendations are derived from these systematic reviews, and best practice statements made where evidence was not available. Evidence was weighed in light of benefits and harms to arrive at a recommendation. The certainty of the evidence for some recommendations was modified in this update with a more refined application of the GRADE framework centred around patient important outcomes. This is highlighted in the rationale section of this update. A note is also made where the newly identified evidence did not alter the strength or certainty of evidence for previous recommendations.The recommendations presented here continue to cover various aspects of diagnosing soft tissue and bone infections, including the classification scheme for diagnosing infection and its severity. Guidance on how to collect microbiological samples, and how to process them to identify causative pathogens, is also outlined. Finally, we present the approach to treating foot infections in persons with diabetes, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and bone infections; when and how to approach surgical treatment; and which adjunctive treatments may or may not affect the infectious outcomes of diabetes‐related foot problems.We believe that following these recommendations will help healthcare professionals provide better care for persons with diabetes and foot infections, prevent the number of foot and limb amputations, and reduce the patient and healthcare burden of diabetes‐related foot disease.

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Section: Rationalementioning

confidence: 99%

IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes‐related foot infections (IWGDF/IDSA 2023)

Senneville,

Albalawi,

van Asten

et al. 2023

Diabetes Metabolism Res

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“…9,[25][26][27]31 One RCT of low quality compared the efficacy of systemic antibiotics (intravenous ciprofloxacin 200 mg bid) either with or without gentamicin cream for the treatment of DFIs in 140 patients (70 each group) who underwent surgical intervention for infected or necrotic tissue removal. 26 Patients with DFO, ischaemic foot, severe immune suppressions, patients already using gentamicin, alcohol or substance abusers were excluded from the study. Clinical cure was defined as the absence of clinical signs of infection, and negative culture swab 7 days after the intervention.…”

Section: Summary Of the Literaturementioning

confidence: 99%

“…Memon 2022, 26 Mendame Ehya 2021, 27 Qin 2019, 31 Brodell 2021, 9 Marson 2018. 25 References prior to 2018…”

Section: References 2018-2022mentioning

confidence: 99%

“…Marson (2018) 25 Low Memon (2022) 26 Low Mendame Ehya (2021) 27 Low Pham (2021) 28 Low Pham (2022) 29 Moderate Pratama (2022) 30…”

Section: Moderatementioning

confidence: 99%

“…[82][83][84][85] Our recent search identified 5 additional studies on adjunctive treatment in DFI, including 2 RCTs, one systematic review and two retrospective studies. 9,[25][26][27]31 One RCT of low quality compared the efficacy of systemic antibiotics (intravenous ciprofloxacin 200 mg bid) either with or without gentamicin cream for the treatment of DFIs in 140 patients (70 each group) who underwent surgical intervention for infected or necrotic tissue removal. 26 Patients with DFO, ischaemic foot, severe immune suppressions, patients already using gentamicin, alcohol or substance abusers were excluded from the study.…”

Section: Summary Of the Literaturementioning

confidence: 99%

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Interventions in the management of diabetes‐related foot infections: A systematic review

Peters,

Albalawi,

van Asten

et al. 2023

Diabetes Metabolism Res

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The optimal approaches to managing diabetic foot infections remain a challenge for clinicians. Despite an exponential rise in publications investigating different treatment strategies, the various agents studied generally produce comparable results, and high‐quality data are scarce. In this systematic review, we searched the medical literature using the PubMed and Embase databases for published studies on the treatment of diabetic foot infections from 30 June 2018 to 30 June 2022. We combined this search with our previous literature search of a systematic review performed in 2020, in which the infection committee of the International Working Group on the Diabetic Foot searched the literature until June 2018. We defined the context of the literature by formulating clinical questions of interest, then developing structured clinical questions (Patients‐Intervention‐Control‐Outcomes) to address these. We only included data from controlled studies of an intervention to prevent or cure a diabetic foot infection. Two independent reviewers selected articles for inclusion and then assessed their relevant outcomes and methodological quality. Our literature search identified a total of 5,418 articles, of which we selected 32 for full‐text review. Overall, the newly available studies we identified since 2018 do not significantly modify the body of the 2020 statements for the interventions in the management of diabetes‐related foot infections. The recent data confirm that outcomes in patients treated with the different antibiotic regimens for both skin and soft tissue infection and osteomyelitis of the diabetes‐related foot are broadly equivalent across studies, with a few exceptions (tigecycline not non‐inferior to ertapenem [±vancomycin]). The newly available data suggest that antibiotic therapy following surgical debridement for moderate or severe infections could be reduced to 10 days and to 3 weeks for osteomyelitis following surgical debridement of bone. Similar outcomes were reported in studies comparing primarily surgical and predominantly antibiotic treatment strategies in selected patients with diabetic foot osteomyelitis. There is insufficient high‐quality evidence to assess the effect of various recent adjunctive therapies, such as cold plasma for infected foot ulcers and bioactive glass for osteomyelitis. Our updated systematic review confirms a trend to a better quality of the most recent trials and the need for further well‐designed trials to produce higher quality evidence to underpin our recommendations.

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Four Decades of Foot and Ankle Research Activity: A Scientometric study of Subspecialty Foot and Ankle Journals

Wu¹,

Qin²,

Chen³

et al. 2023

Pak J Med Sci

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Objectives: To evaluate foot and ankle documents using scientometric methods and provide insight into global research activities. Methods: This scientometric study was conducted at the Department of Spine Surgery, Ganzhou People’s Hospital, China. Documents on foot and ankle from 1980 to 2019 were retrieved from the Scopus database. The number of documents, year of publication, journal, country, institution, author, h-index, and top-cited documents were analyzed. Results: In total, 11313 documents were retrieved. The annual research output on foot and ankle showed a dramatic increase over the past four decades, especially in the past decade (p = 0.000). Foot & Ankle International published the biggest number of documents (44.48%). The United States contributed more than half (52.17%) of the global production, followed by the United Kingdom (11.39%), and Germany (3.62%). The United States had the highest h-index (109). The Hospital for Special Surgery (1.87%) ranked first in terms of productivity, followed by Union Memorial Hospital (1.37%), and Duke University Medical Center (1.24%). The most productive author was Myerson MS (1.25%), followed by Schon LC (0.77%), and Hyer CF (0.74%). Conclusion: Research on foot and ankle has thrived rapidly over the past four decades, particularly in the last decade. The United States contributes the most to the quantity and quality of foot and ankle documents. doi: https://doi.org/10.12669/pjms.39.4.7229 How to cite this: Wu Y, Chen Q, Chen R, Luo Q. Four Decades of Foot and Ankle Research Activity: A Scientometric study of Subspecialty Foot and Ankle Journals. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7229 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Comparison of efficacy of systemic antibiotics alone and combination of systemic antibiotics with gentamicin cream in diabetic foot infections

Cited by 3 publications

References 20 publications

IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes‐related foot infections (IWGDF/IDSA 2023)

IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes‐related foot infections (IWGDF/IDSA 2023)

Interventions in the management of diabetes‐related foot infections: A systematic review

Four Decades of Foot and Ankle Research Activity: A Scientometric study of Subspecialty Foot and Ankle Journals

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