L97/L08.8 + (E10.5/E11.5/E12.5/E13.5/E14.5)
GENERAL MEASURES
Metabolic control.
Treat underlying comorbidity (e.g.: corns, alcohol misuse, ingrown toenails).
Relieve pressure: non-weight bearing is essential.
Smoking cessation is essential.
Deep (limb-threatening) infection
X-ray of affected limb.
Surgical drainage as soon as possible with removal of necrotic or poorly vascularised tissue, including infected bone – refer urgently.
Revascularisation, if necessary.
Local wound care
Frequent wound debridement with scalpel, e.g. once a week.
Frequent wound inspection.
Absorbent, non-adhesive, non-occlusive dressings.
Superficial ulcer with extensive infection
Debridement with removal of all necrotic tissue.
MEDICINE TREATMENT
Superficial ulcer with extensive infection
Antibiotic therapy
For polymicrobial infection:
Topical antibiotics are not indicated.
- Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 10 days.
- Longer course of therapy may be necessary.
Severe infection
- Amoxicillin/clavulanic acid, IV, 1.2 g 8 hourly.
Severe penicillin allergy (Z88.0)
- Clindamycin, oral, 150–450 mg 8 hourly.
AND
- Gentamicin, IV, 6 mg/kg daily (see GENTAMICIN, IV for guidance on prescribing).
REFERRAL
Arterial revascularisation procedures.