LIPSKY BA; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1999 Sep 26-29; 39: 762 (abstract no. 1111).
VA Puget Sound Health Care System, Seattle, WA.
Diabetic foot ulcers often become infected, and may progress to involve deeper soft tissue or bone. These infections may be polymicrobial and antibiotic therapy must supplement local wound care. For mild non-limb threatening infections outpatient therapy is safe and effective. Oral antibiotics are traditionally used but bioavailability may be limited or absorption impaired. Tissue antibiotic levels, particularly in ischemic limbs, are often subtherapeutic. Furthermore, the incidence of antibiotic resistant bacteria causing these infections is rising. Another approach to treating infected foot ulcers is topical antimicrobial therapy. This route achieves high antibiotic levels at the infected site, while avoiding systemic microbial alterations and adverse effects. Topical therapy also emphasizes to the patient and provider the importance of wound care. While most antiseptics are toxic to host tissues, topical antibiotics are well-tolerated. To date, however, none of the approved agents have been studied in diabetic foot infections. A novel investigational agent that may overcome these problems is topical 1% pexiganan acetate cream (Locilex d, Magainin Pharmaceuticals, Inc.). Two recent blinded randomized controlled multicenter trials compared topical pexiganan with oral ofloxacin in a total of 835 diabetic patients with a mildly infected ulcer. The clinical response rate at end of 14-28 days of therapy was 85%-90% for both groups, and the microbiological response and wound healing rates were statistically equivalent. Furthermore, the mechanism of action of this peptide antibiotic differs from those of systemic agents; studies have shown no cross-resistance between them. Thus, topical antibiotic therapy may be an important evolution in the therapy of diabetic foot infections.
Publication Types:
Keywords:
- Anti-Bacterial Agents
- Anti-Infective Agents
- Antimicrobial Cationic Peptides
- Diabetic Foot
- Humans
- Infection
- Ofloxacin
- Peptides
- drug therapy
- pexiganan
Other ID:
UI: 102245964
From Meeting Abstracts