Thực nghiệm điều trị với kháng sinh trong nhiễm trùng chân nặng nên luôn luôn bao gồm các đại lý chống lại tụ cầu, Enterobacteriaceae và các vi khuẩn yếm khí. Trong trường hợp này, hai đại lý với sinh khả dụng xương tốt được sử dụng kể từ khi viêm xương tủy là hiện. | 182 Atlas of the Diabetic Foot Figure Large neuro-ischemic ulcer with gross purulent discharge on the posterior surface of right heel. The calcaneus is exposed Empirical treatment with antibiotics in severe foot infections should always include agents against staphylococci enterobacte-riaceae and anaerobes. In this case two agents with good bone bioavailability were used since osteomyelitis was present. Therapeutic options in patients with severe foot infections include Fluoroquinolone plus metronidazole or clindamycin. This combination is effective against Staphylococcus aureus only methicillin-susceptible strains entero-bacteriaceae and anaerobes. f -lactam and f -lactamase inhibitor combinations ticarcilline-clavulanic acid piperacillin - tazobactam . Ampicillin - sulbactam is particularly active against Enterococcus spp. For patients who have received extensive antibiotic therapy ticarcilline-clavulanic acid or pipera-cillin-tazobactam may be preferred because of their increased activity against nosocomial gram-negative bacilli. Such regimens are also effective against Infections 183 Figure Plain radiograph of the foot illustrated in Figure showing a large skin defect on the posterioplantar aspect of the heel and bone resorption of the posterior calcaneus. Calcinosis of the posterior tibial artery and medial plantar branch artery is also apparent Staphylococcus aureus only methicillin sodium-susceptible strains Streptococcus spp. and most anaerobes. In patients who have severe penicillin allergy combination therapy with aztre-onam and clindamycin or a fluoroquinolone and clindamycin is effective. Imipenem-cilastin or meropenem as monotherapy. Doctors should always consider that Modification of the treatment may be necessary according to the results of cultures. Vancomycin or teicoplanin are indicated in cases of infection with methicillin-resistant staphylococcal strains. Third generation cephalosporins should be used only in combination with .
