We evaluated the bacteriological and clinical efficacy of the
combination of ciprofloxacin /clindamycin in severe diabetic foot
infections and we tried to elucidate the relationship between the
vascular status of the lower limbs and the outcome of these infections.
Initial empirical antibiotic therapy with ciprofloxacin (300 mg/ 12 hrs
IV) and clindamycin (600 mg/8 hrs IV) was administered in 84
hospitalized diabetics with severe lower limb infections. This treatment
was continued only in cases with primary clinical improvement. The major
endpoints of treatment were: cure, improvement and failure. Evaluation
of the vascular status of the lower extremities was performed by high
resolution imaging coloured ultrasonography, US-Doppler and TcPO2
measurements.
Polymicrobial flora was found in 83% of the cases with an average 2.8
species per specimen. Osteomyelitis was detected in 58% of the
patients. After five days of IV administration of ciprofloxacin and
clindamycin the response rate was 95.2%. After three weeks of therapy
the clinical outcome was: cure 54.8%, improve ment 23.8%, and failure
21.4%. The long term follow up (mean duration 16 months) revealed
complete healing of the skin lesions in 63 patients (75%). Unfavorable
prognostic factors for these infections were: ankle systolic blood
pressure <50 mmHg or toe systolic blood pressure <30 mmHg and TcPO2 < 20
mmHg. The side effects of the combination of ciprofloxacin/clindamycin
were mild and there were no cases of pseudomembranous enterocolitis.
The combination of ciprofloxacin/clindamycin was found to provide an
excellent empirical as well as definitive treatment of severe diabetic
foot infections. The evaluation of the vascular status and the severity
of ischaemia of the lower limbs has a strong predictive value in the
outcome of these infections
