Infection control

Optimal management of diabetes related foot infection can potentially reduce the incidence of infection related morbidities, the need for and duration of hospitalisation and the incidence of major limb amputation15,16. Infection in the diabetic foot has been classified into mild, moderate and severe (see table 1) to help guide treatment regimes. In all these cases appropriate antibiotic therapy is the treatment of choice. An empirical antibiotic regimen should be based on the severity of infection and the likely aetiological agents17. There is limited evidence with which to make informed choices among the various antibiotic agents.

Foot ulcer severity


Presence of 2 or more signs of inflammation (pus, erythema, pain, warmth, tenderness, induration). Cellulitis if present < 2cm from the ulcer in the absence of clinical signs of systemic toxicity and infection involving the superficial tissues.


As in ‘mild’ above, with cellulitis > 2cm from the wound but <5cm; no signs of systemic toxicity; infection is spreading to deeper tissue and bone.


Extensive cellulitis, deep abscess with or without signs of systemic toxicity (fever, vomiting, hypotension, confusion, acidosis, renal failure, severe hyperglycaemia, leukocytosis).