❌ When NOT to Treat with Antibiotics
**Uninfected foot ulcers (Grade 1) should NOT be treated** with systemic or local **antibiotics** to promote ulcer healing due to:
- Increased risk of **adverse events**.
- Possible **collateral damage** to the commensal flora.
- Risk of **antibiotic resistance & drug interactions**.
🏥 When to Consider Hospitalization?
**Hospitalization** is necessary for **Grade 4 infections** and **Grade 3 infections with comorbidities** such as:
- Severe peripheral arterial disease (PAD)
- Osteomyelitis requiring prolonged treatment
- Systemic inflammatory response syndrome (SIRS)
💊 Treatment Guidelines
**Antibiotic therapy should be based on the severity**:
- Grade 2 (Mild Infection): Target **aerobic gram-positive pathogens (including MRSA)**.
- Grade 3 (Moderate Infection): Consider **early surgical debridement** along with antibiotics.
- Grade 4 (Severe Infection): Broad-spectrum IV antibiotics & urgent hospitalization.
❌ **Do NOT target Pseudomonas aeruginosa unless isolated from cultures or clinically suspected.**
⏳ Duration of Antibiotic Therapy
- **Mild infections:** 1-2 weeks
- **Moderate infections:** 3-4 weeks (if PAD is present)
- **Osteomyelitis:** 6 weeks (if no amputation or bone resection is performed)
🔪 When is Surgery Required?
**Early surgical intervention (within 24-48 hours)** is recommended for **moderate & severe DFIs** to:
- Remove **necrotic tissue**.
- Prevent **further spread of infection**.
- Improve **healing outcomes**.
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