Module 9 Part 2 Cellulitis – Special Considerations Diabetic Foot

Question 1

What are the probable organisms causing cellulitis in the diabetic foot (mild to moderate or non-limb threatening)?

Answer 1

Staphylococcus aureus, Group A Streptococcus, Group B Streptococcus, Enterococci, Pseudomonas aeruginosa, and mixed aerobic and anaerobic bacteria.

Question 2

What are the first-line treatment options for mild to moderate diabetic foot cellulitis?

Answer 2

TMP/SMX OR Cephalexin PLUS Metronidazole.

Question 3

What is the usual dosage for TMP/SMX in mild to moderate diabetic foot cellulitis?

Answer 3

1-2 double-strength (DS) tablets BID.

Question 4

What is the first-line treatment for mild to moderate diabetic foot cellulitis if Pseudomonas is suspected?

Answer 4

Use Cephalexin PLUS Metronidazole.

Question 5

What are the second-line treatment options for mild to moderate diabetic foot cellulitis?

Answer 5

Amoxicillin/Clavulanate OR TMP/SMX PLUS Clindamycin.

Question 6

What is the recommended treatment if deep cultures reveal anaerobic involvement in diabetic foot cellulitis?

Answer 6

Add metronidazole or clindamycin based on severity and location.

Question 7

Why is coverage for methicillin-resistant S. aureus (MRSA) considered in some areas for diabetic foot cellulitis?

Answer 7

Because MRSA prevalence may be high (>10-15% of S. aureus) or in patients with certain risk factors.

Question 8

What antibiotics are active against community-acquired MRSA (CA-MRSA) in diabetic foot cellulitis?

Answer 8

TMP/SMX and doxycycline.

Question 9

When should you consider IV antibiotics in diabetic foot cellulitis treatment?

Answer 9

Consider IV antibiotics if oral absorption is compromised, especially in diabetic patients.

Question 10

What is the third-line treatment for diabetic foot cellulitis?

Answer 10

Cefazolin (IV) at 1-2 g q8h PLUS one of the following: Metronidazole (IV) at 2500 mg q12h or Clindamycin (IV) at 600 mg q8h.

Question 11

How can severe cellulitis in a diabetic foot be identified?

Answer 11

Severe cellulitis is indicated by systemic toxicity, deep tissue involvement, or spreading erythema (>2 cm).

Question 12

What are the common probable organisms causing cellulitis in a diabetic foot?

Answer 12

Staphylococcus aureus, Group A Streptococcus, Group B Streptococcus, Enterococci, Pseudomonas aeruginosa, and mixed aerobic and anaerobic bacteria.

Question 13

What is the first-line treatment for severe cellulitis in a diabetic foot?

Answer 13

Ceftriaxone (IM/IV) or Cefotaxime (IV) in addition to either Metronidazole or Clindamycin.

Question 14

What is the second-line treatment for severe cellulitis in a diabetic foot?

Answer 14

Ciprofloxacin (PO/IV) along with either Metronidazole or Clindamycin.

Question 15

When should empiric coverage for MRSA be considered?

Answer 15

Consider it in areas with common MRSA prevalence or if the patient has a history of antibiotic use or recent hospital admissions.

Question 16

What are the risk factors for Pseudomonas infection in diabetic foot cellulitis?

Answer 16

Warm climate, frequent foot exposure to water, treatment failure with antibiotics not effective against Pseudomonas, and severe diabetic foot infection.