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Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review

Along with the increasing global burden of diabetes, diabetic foot infections (DFI) and diabetic foot osteomyelitis (DFO) remain major challenges for patients and society. Despite progress in the development of prominent international guidelines, the optimal medical treatment for DFI and DFO remains...

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Autores principales: Soldevila-Boixader, Laura, Fernández, Alberto Pérez, Laguna, Javier Muñoz, Uçkay, Ilker
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854429/
https://www.ncbi.nlm.nih.gov/pubmed/36671326
http://dx.doi.org/10.3390/antibiotics12010124
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author Soldevila-Boixader, Laura
Fernández, Alberto Pérez
Laguna, Javier Muñoz
Uçkay, Ilker
author_facet Soldevila-Boixader, Laura
Fernández, Alberto Pérez
Laguna, Javier Muñoz
Uçkay, Ilker
author_sort Soldevila-Boixader, Laura
collection PubMed
description Along with the increasing global burden of diabetes, diabetic foot infections (DFI) and diabetic foot osteomyelitis (DFO) remain major challenges for patients and society. Despite progress in the development of prominent international guidelines, the optimal medical treatment for DFI and DFO remains unclear as to whether local antibiotics, that is, topical agents and local delivery systems, should be used alone or concomitant to conventional systemic antibiotics. To better inform clinicians in this evolving field, we performed a narrative review and summarized key relevant observational studies and clinical trials of non-prophylactic local antibiotics for the treatment of DFI and DFO, both alone and in combination with systemic antibiotics. We searched PubMed for studies published between January 2000 and October 2022, identified 388 potentially eligible records, and included 19 studies. Our findings highlight that evidence for adding local antibiotic delivery systems to standard DFO treatment remains limited. Furthermore, we found that so far, local antibiotic interventions have mainly targeted forefoot DFO, although there is marked variation in the design of the included studies. Suggestive evidence emerging from observational studies underscores that the addition of local agents to conventional systemic antibiotics might help to shorten the clinical healing time and overall recovery rates in infected diabetic foot ulcers, although the effectiveness of local antibiotics as a standalone approach remains overlooked. In conclusion, despite the heterogeneous body of evidence, the possibility that the addition of local antibiotics to conventional systemic treatment may improve outcomes in DFI and DFO cannot be ruled out. Antibiotic stewardship principles call for further research to elucidate the potential benefits of local antibiotics alone and in combination with conventional systemic antibiotics for the treatment of DFI and DFO.
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spelling pubmed-98544292023-01-21 Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review Soldevila-Boixader, Laura Fernández, Alberto Pérez Laguna, Javier Muñoz Uçkay, Ilker Antibiotics (Basel) Review Along with the increasing global burden of diabetes, diabetic foot infections (DFI) and diabetic foot osteomyelitis (DFO) remain major challenges for patients and society. Despite progress in the development of prominent international guidelines, the optimal medical treatment for DFI and DFO remains unclear as to whether local antibiotics, that is, topical agents and local delivery systems, should be used alone or concomitant to conventional systemic antibiotics. To better inform clinicians in this evolving field, we performed a narrative review and summarized key relevant observational studies and clinical trials of non-prophylactic local antibiotics for the treatment of DFI and DFO, both alone and in combination with systemic antibiotics. We searched PubMed for studies published between January 2000 and October 2022, identified 388 potentially eligible records, and included 19 studies. Our findings highlight that evidence for adding local antibiotic delivery systems to standard DFO treatment remains limited. Furthermore, we found that so far, local antibiotic interventions have mainly targeted forefoot DFO, although there is marked variation in the design of the included studies. Suggestive evidence emerging from observational studies underscores that the addition of local agents to conventional systemic antibiotics might help to shorten the clinical healing time and overall recovery rates in infected diabetic foot ulcers, although the effectiveness of local antibiotics as a standalone approach remains overlooked. In conclusion, despite the heterogeneous body of evidence, the possibility that the addition of local antibiotics to conventional systemic treatment may improve outcomes in DFI and DFO cannot be ruled out. Antibiotic stewardship principles call for further research to elucidate the potential benefits of local antibiotics alone and in combination with conventional systemic antibiotics for the treatment of DFI and DFO. MDPI 2023-01-09 /pmc/articles/PMC9854429/ /pubmed/36671326 http://dx.doi.org/10.3390/antibiotics12010124 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Soldevila-Boixader, Laura
Fernández, Alberto Pérez
Laguna, Javier Muñoz
Uçkay, Ilker
Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review
title Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review
title_full Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review
title_fullStr Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review
title_full_unstemmed Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review
title_short Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review
title_sort local antibiotics in the treatment of diabetic foot infections: a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854429/
https://www.ncbi.nlm.nih.gov/pubmed/36671326
http://dx.doi.org/10.3390/antibiotics12010124
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