Neuroischaemic ulcers

We prescribe antibiotics more readily for the neuroischaemic foot because untreated infections in neuroischaemic feet lead rapidly to extensive necrosis, destruction of the foot and major amputation. • At the first visit, if the ulcer is superficial, we prescribe oral amoxicillin 500 mg tds and flucloxacillin 500 mg qds. (If the patient is penicillin allergic, we prescribe erythromycin 500 mg qds or cefadroxil 1 g bd.) If the ulcer is deep, extending to subcutaneous tissues, we add trimethoprim 200 mg bd or ciprofloxacin 500 mg bd, and metronidazole 400 mg tds to cover Gram-negative and anaerobic organisms that may be present in the deep tissues. If, on review, the neuroischaemic ulcer shows no signs of infection and the swab is negative, antibiotics may be stopped. However, in cases of severe ischaemia (pressure index < 0.5) we may continue antibiotics until the ulcer is healed. If the neuroischaemic ulcer has a positive swab, the patient is treated with the appropriate antibiotic, according to antibiotic sensitivities until the repeat swab, taken at weekly intervals, is negative • At every patient visit, examination for local signs of infection, cellulitis or osteomyelitis is performed. If these are found, action, including antibiotic therapy, is taken as described in Chapter 5.

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