**4.5 Antibiotic stewardship and clinical pathways**

DFO's are probably among the most frequent diseases leading to antibiotic overuse [60]. We think that the principles of antibiotic stewardship should also concern DFOs. We reviewed the literature on DFO [60] to assess the value of antibiotic stewardship in the management of DFO. According to this review, the three most effective measures could be: correct diagnosis of bone infection; use of antibiotic regimens with the narrowest spectrum; and, limiting the duration of antimicrobial treatment. Clinical pathways have been instituted for DFOs [70]. A multidisciplinary management regularly showed a significant reduction in amputation risks [71]. However, these multidisciplinary teams have also their limitations: 1) it is difficult to bring the team members together; 2) the number of patients requiring evaluation often exceeds the capacity of fixed regular meetings; 3) the meetings are timeconsuming and key members may be absent. Theoretically, order-sets (especially if they are embedded within interactive electronic websites) [12] are tools to implement "bundles" of approaches and, hopefully, improve outcomes. However, the academic experience of these order sets must be further evaluated, especially in resource-poor settings. There are also many administrative approaches that might improve antibiotic stewardship in DFO. Governments can initiate diabetic foot centers [72], or regular workshops and public educational lectures. The access to regional or international guidelines must be encouraged [60].
