Precautionary measurements and rationale use of antibiotics in diabetic foot ulcer can save amputation: A case report

Abstract

Diabetic foot is one of the major and most frequently occurring complications of diabetes mellitus (DM). There are many underlying factors for the development of diabetic foot ulcer. Among these factors poor supply of blood to lower extremities due to increase peripheral resistance in blood vessels (PVD), presence of Ischemia, infection or trauma to foot. The present case report is under discussion to rationalize the proper use of antibiotics in diabetic foot ulcer and a few safety recommendations. A male diabetic patient with 25 years span of diabetes was reported with some complications regarding small ulcer on big toe of right foot. The patient was in usual state of health when he noticed putrid smell and drainage of pus on the big toe of right foot. Patient was carrying insulin dependent diabetes mellitus (IDDM) with well controlled sugar level. He had gone through amputation of left knee and 2nd phalange of right foot. Currently, the patient was under uncontrolled hypertension and was gradually moving towards complications of diabetes. He was on the following medication during his hospital stay: Pletal tablet 50 mg BD (cilostazol for peripheral vasodilation), Oflobid tablet (ofloxacin) 200 mg BD (anti-bacterial), Amlocard tablet 5 mg BD (that is amlodipine), Surbex-Z tablet BD (multi-vitamins), vomilux tablet 10 mg (para-aminobenzoic acid as anti-spasmodic), methycobal tablet 500 mg BD and loftyl tablet 150 mg (buflomedil for chronic venous insufficiency). During hospital stay, patient was treated with third generation cephalosporin (rocephin injection 1G BID) and ofloxacin for follow up therapy. Patient has hepatitis C positive. Critically observing the treatment offered for diabetic foot ulcer does not justify the pathophysiology of disease. Microbial flora coverage and aggressive treatment was nowhere in the course of therapy. In follow up visits, no precautions were given to the patient to avoid further amputation. The aim of this study is to emphasize the need of appropriate selection of antibiotics and dosage form of antibiotics. Moreover, this study focuses on aggressive treatment of diabetic foot ulcer. This case report is serving as continuous medical education activity for medical professionals as well as sufferers. Key words: Diabetes, trauma, hypertension, Type II DM, peripheral vascular disease (PVD), medication, hepatitis C.