*Current Perspective of Prevention and Management of Diabetic Foot DOI: http://dx.doi.org/10.5772/intechopen.108197*

are required for the selection and duration of antibiotic treatment [24]. A wound culture-based antibiotic regimen has also been shown to benefit diabetic foot ulcers with superadded infection [15]. Microorganism resistance should be considered while choosing a treatment. Microorganism resistance should be considered while choosing a treatment. Oral antibiotics with Gram-positive germ activity for minor infections [25] as well as antibiotics active on Gram-positive as well as Gram-negative bacteria, which includes anaerobic bacteria, for moderate to terribly severe infections [16].

Patients who exhibit any of the risk factors stated on and in the box should be sent to the hospital right away for prompt care and assessment. They need to stay in bed and immediately begin receiving intravenous antibiotics. It could be necessary to use an intravenous insulin pump to regulate blood glucose levels.

Antibiotics: Bacteriological cultures require a broad spectrum of antibiotic coverage within the first 24 hours. Quadruple therapy may include amoxicillin, flucloxacillin, metronidazole (for anaerobes), and either ceftazidime 1 g three times daily or gentamicin (for Gram-negative organisms). When the outcomes of the bacteriological culture are available, this treatment can be modified. Multiple resistant *Staphylococcus aureus* (MRSA) is a severe issue because, first, it can cause sepsis' devastating effects and, second, these individuals need isolation while in the hospital. Both intramuscular teicoplanin and intravenous vancomycin are available as therapies (**Figure 1**) [24].

Analgesics: Peripheral neuropathy, ischemia, and infection are the three main causes of pain in diabetic feet. With other painful conditions, the treatment is comparable. The WHO analgesic ladder suggests using straightforward analgesics for mild to moderate pain, for example, paracetamol or a non-steroidal anti-inflammatory drug.


#### **Figure 1.**

*Treatment algorithm for the diabetic foot. Note: From Ref. [26].*

#### *Diabetic Foot - Recent Advances*

In moderate pain, additional mild opioids such as dihydrocodeine or tramadol should be taken into consideration. Patients experiencing moderate to severe pain should be given potent opioids, such as morphine. In neuropathic pain, adjuvants are used at all levels of the analgesic ladder. Adjuvants include, for instance, antidepressants like amitriptyline and anticonvulsants like duloxetine (e.g. gabapentin or pregabalin) (**Tables 1** and **2**).

Surgical debridement is required to flush pus and abscess cavities as well as remove all gangrenous and contaminated tissue, such as osteomyelitis-related devitalized and infected bone. It is advised to send deep tissue swabs to the lab. If necrosis has occurred in the digit, a ray amputation to remove the toe and a portion of its accompanying metatarsal is required in the neuropathic foot with intact circulation. In some cases, skin grafting is required to hasten wound healing [24].
