Diabetic foot infection is a frequent complication in long-standing
diabetes mellitus. For antimicrobial
therapy of this
infection, both the optimal duration and the route of administration are often based more on expert opinion than on published evidence. We reviewed the scientific literature, specifically seeking prospective trials, and aimed at addressing two clinical issues: (1) shortening the currently recommended
antibiotic duration and (2) using oral (rather than parenteral)
therapy, especially after the patient has undergone
debridement and revascularization. We also reviewed some older key articles that are critical to our understanding of the treatment of these
infections, particularly with respect to
diabetic foot osteomyelitis. Our conclusion is that the maximum duration of
antibiotic therapy for
osteomyelitis should be no more than to 4-6 weeks and might even be shorter in selected cases. In the future, in addition to conducting randomized trials and propagating national and international guidance, we should also explore innovative strategies, such as intraosseous
antibiotic agents and bacteriophages.