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Tất cả những yếu tố này hỗ trợ lời cầu xin thường nghe hợp lý hơn trong việc quy định các đại lý kháng sinh. Chương này xem xét các bằng chứng cho thấy hiện có sẵn để giúp các bác sĩ đạt được mục tiêu này. Có một số câu hỏi chung mà cần được trả lời trong cách tiếp cận hợp lý để lựa chọn kháng sinh. Đầu tiên là câu hỏi có hay không nhiễm trùng. | 144 The Foot in Diabetes are more appropriate in some circumstances such as non-limb-threatening cellulitis. All of these factors support the commonly-heard plea to be more rational in the prescription of antibiotic agents. This chapter examines the evidence that is available to help clinicians achieve this goal. There are several general questions that should be answered in the rational approach to antibiotic selection. First is the question of whether or not infection is present. There remains some controversy over whether all colonized foot ulcers are infected but most authors have suggested that the absence of inflammatory findings implies the absence of infection6-8. Second the severity of infection should be carefully assessed by careful bedside inspection and palpation. Gently exploring the wound with a surgical probe and debridement of necrotic tissue should be part of the comprehensive initial examination. Third an assessment of the likely microbiological aetiology of infection is critical in choosing appropriate empiric agents. This depends on the severity and extent of infection and whether recent treatment with antibiotics may have altered the local flora. Fourth an analysis of host factors that may impact on toxicity should be undertaken. For example neurotoxicity is more likely with imipenem if the patient has known neurological disease. Prior drug allergy should be carefully explored. Pre-existing renal disease may make nephrotoxicity more likely with aminoglycosides which should generally be avoided in the diabetic patient. Last the antimicrobial spectrum pharmacodynamic properties and cost of specific agents are major factors that help the clinician select a regimen tailored to the specific needs of the individual patient. THE UNCOMPLICATED NEUROPATHIC ULCER Like most wounds virtually all foot ulcers are colonized with a variety of bacterial flora. The open lesion is an ideal micro-environment for the growth of bacteria and swabs of uninflamed .
