**4.1 Pharmacological approach**

The selection of appropriate treatments should be based on the results of a wound culture once an infection is suspected. For accurate results during wound culture, it is ideal to harness tissue from the base of the ulcer after debridement rather than taken from a superficial wound [131, 132]. If deep tissue infections are suspected, specimens obtained aseptically during surgery provide optimal results. Chronic or previously treated wounds most often show polymicrobial growth, including Gram-positive cocci, Gram-negative rods or anaerobes and fungi in some cases [133]. Antibiotic-resistant organisms such as vancomycin-resistant *S. aureus* and methicillin-resistant *S. aureus* are frequently found in patients previously treated with antibiotic therapy or patients with a recent history of hospitalization or residence in a long-term care facility [134, 135]. The selection of appropriate antimicrobial therapy, including the agent, route of administration, and need for inpatient or outpatient treatment will be determined in part by the severity of the infection. In-patient admissions should be offered to individuals with systemic signs of severe infection with the provision of supportive care and intravenous antibiotic therapy based on result obtained from wound culture [136, 137]. Common classes of pharmacological agents used include lincosamides, fluoroquinolones, β-lactams/βlactamase inhibitors [138, 139], and exogenous sources of agents such as nitric oxide that stimulate angiogenesis and vasodilation.
