Diabetes guidance 1766.pdf - East Cheshire NHS Trust

Active Foot DiseaseUlcerRefer to Specialist Podiatry Team: 01270 273 033Low grade ulcers / systemically well:Initial Actions:• Swab wound• Provide empirical antibiotic treatment for 7 days.- Co-amoxiclav 500/125mg tdsOr for penicillin-allergic patients- Doxycycline 100mg bd + metronidazole 400mg tds.• Dress with an antimicrobial dressing- Low exudate wounds – Inadine or Urgotul SSD or Atrauman silver- High exudate wounds – Aquacel Ag- Silver dressings should be stopped once the course of antibiotics is complete- For further advice contact Tissue Viability Nurse (contact 01270 275315).• Ensure foot is elevated and rested.• Consider Admission if systemically unwell.Diabetic foot infections range from simple acute cellulitis to chronic osteomyelitis and always requireaggressive management. In more complex patients (e.g. those over 75 years and / or history of C. difficilediarrhoea) discussion with microbiologist is recommended.If first line treatment has not worked then consider swab result or discuss with microbiologist.Systemically unwell / limb threatening infection:This is a Medical Emergency. Admit for assessment and treatment according to hospital antibiotic guidelines.Critical IschaemiaIndicated by pain at rest, pale/mottled feet, gangrene or claudication.Refer to Vascular Consultant or admit to hospital as an emergency.