Source control and wound management
›Local management essentials
›Debridement planning
›Remove necrotic tissue
›Callus paring
›Deep tissue sampling at debridement
›Abscess management
›Incision and drainage
›Packing strategy individualized
›Offloading strategy
›Total contact cast when appropriate
›Removable walker boot if adherence feasible
›Moist wound environment
›Dressing selection based on exudate
›Avoid caustic antiseptics on viable tissue
›Tetanus prophylaxis alignment
›Booster status review
›Immunoglobulin if indicated by immunization history and wound type
Empiric antibiotics by severity
›Antibiotic principles
›Start timing targets
›If sepsis physiology, initiate IV antibiotics within 1 hour (Class I)
›If moderate infection, initiate within 3 hours when cultures obtained
›Coverage targets
›Mild infection coverage primarily gram-positive cocci
›Moderate infection broaden to polymicrobial coverage
›Severe infection broad coverage including MRSA and anaerobes
›Culture guided de-escalation
›Narrow spectrum after pathogen identification and clinical response
›Mild infection oral regimens (typical 5 to 14 days)
›First-line options when MRSA risk low
›Cephalexin PO 500 mg every 6 hours
›Renal dosing adjustment if reduced eGFR
›Amoxicillin-clavulanate PO 875 mg every 12 hours
›Avoid if severe beta-lactam allergy
›MRSA risk options
›Doxycycline PO 100 mg every 12 hours
›Avoid in pregnancy and young children
›Trimethoprim-sulfamethoxazole PO 1 to 2 double-strength tablets every 12 hours
›Hyperkalemia risk monitoring
›Beta-lactam anaphylaxis options
›Clindamycin PO 300 to 450 mg every 6 to 8 hours
›C difficile risk counseling
›Moderate infection IV or PO options (typical 1 to 3 weeks based on depth and response)
›Polymicrobial coverage without Pseudomonas risk
›Ampicillin-sulbactam IV 3 g every 6 hours
›Renal dosing adjustment
›Ceftriaxone IV 2 g daily plus metronidazole IV 500 mg every 12 hours
›Alternative if once-daily cephalosporin needed
›MRSA coverage add-on if risk factors or prior colonization
›Vancomycin IV 15 to 20 mg/kg every 8 to 12 hours
›Trough or AUC monitoring per local protocol
›Nephrotoxicity monitoring
›Linezolid PO or IV 600 mg every 12 hours
›CBC monitoring for thrombocytopenia
›Serotonergic drug interaction screening
›Pseudomonas risk options (macerated wounds, frequent soaking, warm climates, prior culture)
›Piperacillin-tazobactam IV 4.5 g every 6 to 8 hours
›Extended infusion per local protocol if available
›Cefepime IV 2 g every 8 to 12 hours plus metronidazole IV 500 mg every 12 hours
›Neurotoxicity risk in renal impairment
›Severe infection and sepsis regimens (initial broad coverage)
›Broad spectrum plus MRSA
›Piperacillin-tazobactam IV 4.5 g every 6 hours
›Renal dosing adjustment
›Monitor sodium load
›Vancomycin IV 15 to 20 mg/kg every 8 to 12 hours
›AUC-guided monitoring preferred when available
›Necrotizing infection adjunct toxin suppression option
›Clindamycin IV 900 mg every 8 hours
›Pair with broad beta-lactam and MRSA agent
›Severe beta-lactam allergy alternatives
›Aztreonam IV 2 g every 8 hours plus metronidazole IV 500 mg every 12 hours
›Add vancomycin for MRSA
›Carbapenem use only if allergy history supports safety with specialist input
›Osteomyelitis management framework
›Diagnostic anchors
›Positive probe-to-bone in high-pretest setting
›MRI supportive findings
›Bone biopsy culture when feasible
›Treatment duration concepts
›After complete surgical resection with clean margins, shorter course possible
›Without resection, prolonged antibiotics typical 6 weeks
›Surgical indications
›Necrotic bone
›Persistent sinus tract
›Failure of medical therapy
›Antibiotic route considerations
›IV to oral switch when clinically improving and oral bioavailability high
Adjunctive medical management
›Supportive care and comorbidity optimization
›Fluid resuscitation for sepsis physiology (Class I)
›Balanced crystalloid bolus guided by perfusion
›Reassess MAP, urine output, lactate trend
›Analgesia strategy
›Acetaminophen dosing within daily limits
›Opioid sparing plan when possible
›Glycemic management
›Insulin protocol alignment for inpatient care
›Avoid sliding scale alone in severe infection
›VTE prophylaxis for admitted patients
›Pharmacologic prophylaxis unless contraindicated
›Smoking cessation support
›PAD and wound healing benefit framing