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Diabetic Foot Osteomyelitis — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionDiabetic Foot OsteomyelitisSCE Infectious Diseases

A 60-year-old man with type 2 diabetes presents with a deep-seated foot infection following a plantar ulcer. MRI shows osteomyelitis of the 3rd metatarsal with a surrounding soft tissue collection. Bone biopsy culture grows Staphylococcus aureus (MSSA) and Bacteroides fragilis. What is the most appropriate antibiotic regimen?

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Correct answer: C — IV Flucloxacillin plus IV Metronidazole for 2 weeks then oral switch for 4 further weeks

Diabetic foot osteomyelitis with mixed aerobic-anaerobic organisms requires combination therapy targeting all cultured pathogens. IV Flucloxacillin covers MSSA and IV Metronidazole covers anaerobes including B. fragilis. Initial IV therapy for 2 weeks with oral step-down (e.g. Flucloxacillin plus Metronidazole oral) for 4 further weeks (total 6 weeks) is standard for osteomyelitis. Co-amoxiclav alone may be acceptable for milder infections but the MRI-confirmed osteomyelitis warrants IV induction.

Reference: NICE NG19 2015 (updated 2019) – Diabetic foot infections; BSAC 2015 – Osteomyelitis guidelines