Volume 16 - Issue -
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A Closer Look At Key Treatment Considerations Part 2
What About The Cost/Benefit Ratio?
Dr. Armstrong: Clearly, linezolid is an expensive drug. Clearly, it coluld be associated with inherent problems just as any drug could be. I’m sure you’re all aware of data from Apelqvist, et. al., that looked at patients’ specific costs with diabetic foot infections.19-21 They implied, I think with very robust numbers, that the overall cost of antibiotics in the treatment regime of a diabetic foot infection patient is less than 5 percent of the total direct cost associated with hospitalization.
While we may be talking about very ex
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References
1. Bailey TS, TM. Yu, et. al. “Patterns of foot examination in a diabetes clinic.” American Journal of Medicine (1985) 78:371-74.
2. Grayson ML, G.W. Gibbons, et. al. “Probing to bone in infected pedal ulcers: a clinical sign of underlying osteomyelitis in diabetic patients.” JAMA (1995) 273(9): 721-723.
3. Lipsky BA, Armstrong DG, Acin F, et. al. Treating diabetic foot infections with linezolid versus aminopenicillins: a randomized international multicenter trial. Abstract 189, Infectious Diseases Society of America, October 25, 2002, Chicago, IL.
4. Armstrong DG, Findlow AH, Oyibo
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Understanding The Impact Of The Diabetic Foot
Dr. Armstrong: How does diabetic foot pathology impact the lives of people in your practice?
Dr. Boulton: Diabetic foot problems are a huge medical, social and economic problem. They result as a consequence of other long-term complications, neuropathy specifically, vascular disease and the interactions of these pathologies with trauma, foot deformity and so on.
The neuropathic foot, with its loss of sensation, is at great risk of ulceration when it interacts with other pathologies. Footwear is also a common problem as people with insensate feet will buy shoes that are too small
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Recognizing Infections And Taking Appropriate Cultures
Dr. Armstrong: When you are faced with a diabetic foot infection, what are your considerations for antibiotic therapy?
Dr. Lipsky: The first question is whether the foot wound is infected or not. That may be a more difficult question to answer than many providers recognize. An ulceration can be colonized or contaminated, but that doesn’t mean it’s infected. We have not yet come to consensus definitions on infection, but we’re close to that. Currently, there are two committees working on issues surrounding diabetic foot infections. One is the International Diabetic Foot Wor
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Diagnosing And Treating Osteomyelitis
Dr. Armstrong: Let’s talk about more of our diagnostic modalities. What about some of the things that have been talked about as gold standards in diagnosing deep infections such as osteomyelitis? What about probing to bone for instance? Is it an accurate means of assessing osteomyelitis? Is it worthwhile? Should we be doing it in all of our patients?
Dr. Lipsky: One study described using this technique for diagnosing osteomyelitis. Because the positive predictive value of the test was 89 percent and it’s cheap and easy to do, people have widely adopted it as a means of diagn
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A Closer Look At Key Treatment Considerations Part 1
Dr. Armstrong: For most mild to moderate diabetic foot infections, should we be aiming to treat gram-negative organisms or anerobes, or should we go straight toward something that gets predominantly gram-positives?
Dr. Joseph: We could all answer that differently and we all have our ways of doing it. One of the ideas behind the aforementioned guidelines committees is to try to establish some guidance in this area.
I’ll just give my feeling on this. Number one, if the ulceration is not infected, you do not treat with antibiotics. The whole issue of bioload has never been answe
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