Considering the Impact of Antibiotic-Related Adverse Events in Diabetic Foot Infection

Our colleagues from the Balgrist have another excellent contribution to the literature. In their recent narrative review, the team dove into the global incidence and severity of antibiotic-related adverse events when treating diabetic foot infections.¹ They looked at prospective trials and observational studies worldwide and found that the most frequent of these adverse events included gastrointestinal intolerances (5-22%, more prevalent with prolonged use of a beta-lactam or clindamycin, or with higher-dose tetracyclines).¹ Symptomatic Clostridium difficile colitis incidence varied depending on the antibiotic agent, but ranged from 0.5-8%.¹ Hepatoxicity was found 5-17% of the time with beta-lactams, and 3% with quinolones. And, serious cytopenias had a 5% incidence with linezolid, and 6% with beta-lactams.¹ The authors also noted a prevalence of nausea with rifampicin, and renal failure with cotrimoxazole. Skin rash reports found them to be rare, but most common with penicillins or cotrimoxazole.¹

The authors advocated to keep duration of antibiotic therapy short and to only use the lowest clinically appropriate dose during treatment. They cited these adverse events as contributors to increased hospitalization times, increased complexity of care, and additional clinical activity that add to increased health care costs.¹

The bottom line is that antibiotic therapy should be looked upon as something more than trivial. It is, in fact, chemotherapy. In general, I find that clinicians are well-informed about potential antibiotic-related adverse events during treatment for diabetic foot infection. However, some AEs may be less known, such as cytopenias associated with linezolid or hepatotoxicity linked to beta-lactams and quinolones. Continuous medical education and staying updated on the latest research is essential for clinicians to be adequately informed on these adverse events.

To reduce or prevent these events, based on my knowledge and experience, there are several steps clinicians can take:

• Keep antibiotic treatment as short as possible, and follow expert guidelines.

• Use the lowest dose that is clinically effective for the issue of concern.

• Aim to promptly recognize and intervene upon any adverse events that do occur.

• When addressing an adverse event, discontinue the antibiotic and institute an alternative treatment option with an improved risk profile if available.

• Make sure that the patient has proper supportive care to assist in recovery from an antibiotic-related adverse event, in conjunction with the multidisciplinary team.

We should all exercise vigilance in monitoring for these antibiotic-related adverse events when treating patients for diabetic foot infections. These at-risk patients are even more so when considering the potential consequences of this added layer of complications. A proactive and knowledgeable approach is advisable reduce the impact of these events and improve overall outcomes.

Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).

Editor’s note: This blog originally appeared here. It is adapted with permission from the author.

Disclaimer: The views and opinions expressed are those of the author(s) and do not necessarily reflect the official policy or position of Podiatry Today or HMP Global, their employees and affiliates. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, association, organization, company, individual, anyone or anything.

References

1. Soldevila-Boixader L, Murillo O, Waibel FWA, et al. The epidemiology of antibiotic-related adverse events in the treatment of diabetic foot infections: a narrative review of the literature. Antibiotics. 2023;12(4):774.