# Systemic antibiotics for diabetes mellitus‐related foot infections: an integrative literature review

## TL;DR

This paper reviews evidence on systemic antibiotics for treating foot infections in people with diabetes, finding that most antibiotics are similarly effective except for ertapenem versus tigecycline.

## Contribution

The study provides a comprehensive review of systemic antibiotic effectiveness for diabetic foot infections, highlighting gaps in current evidence.

## Key findings

- Most antibiotics like beta-lactams, carbapenems, and fluoroquinolones showed comparable clinical results.
- Ertapenem and tigecycline showed significant differences, failing non-inferiority criteria.
- Higher-quality evidence is needed to guide antibiotic choices for diabetic foot infections.

## Abstract

Evidence on antibiotic therapy for diabetic foot infections can help clinical management. The objective of this study was to identify the evidence on systemic antibiotics for treatment of diabetes mellitus-related foot infections. An integrative literature review was conducted of randomized clinical trials, systematic reviews, and meta-analyses. The keywords “Diabetic foot” AND “Antibiotics” were used to search PubMed and 15 articles were selected (nine randomized clinical trials, four systematic reviews, and two meta-analyses). Seven randomized clinical trials revealed clinical results that were comparable for beta lactam antibiotics with beta-lactamase inhibitors, carbapenems, and fluoroquinolones. Two randomized clinical trials found significant differences comparing ertapenem and tigecycline and in analyses of subsets with severe infections between piperacillin-tazobactam and ertapenem. The literature revealed comparable clinical results for different systemic antibiotics used to treat foot infections related to diabetes, except for the difference between ertapenem and tigecycline, which did not meet the parameters for non-inferiority, highlighting the need for higher-quality evidence.

As evidências acerca da antibioticoterapia nas infecções do pé diabético podem auxiliar na terapêutica. O objetivo deste estudo foi identificar as evidências acerca dos antibióticos sistêmicos no tratamento das infecções do pé relacionadas ao diabetes melito. Foi realizada uma revisão integrativa da literatura, incluindo ensaios clínicos randomizados, revisões sistemáticas e metanálises. As palavras-chave “Diabetic foot” AND “Antibiotics” foram utilizadas como descritores na PubMed, sendo selecionados 15 artigos (nove ensaios clínicos randomizados, quatro revisões sistemáticas e duas metanálises). Sete ensaios clínicos randomizados revelaram resultados clínicos comparáveis para os betalactâmicos com inibidores de betalactamases, carbapenêmicos e fluoroquinolonas. Dois ensaios clínicos randomizados mostraram diferenças significativas na comparação entre ertapenem e tigeciclina e na análise do subgrupo de infecções graves entre piperacilina-tazobactam e ertapenem. A literatura aponta resultados clínicos comparáveis para os antibióticos sistêmicos no tratamento das infecções do pé relacionadas ao diabetes, exceto pela diferença entre ertapenem e tigeciclina, que não atingiu os parâmetros de não inferioridade, destacando a necessidade de evidências de maior qualidade.