INDUCE

Patient history

Taking a comprehensive history in relation to the ulcer, their diabetes, and their general health, is an important aspect in assessment. In particular, determining the duration of an ulcer will have a bearing on the type of antibiotic prescribed if the ulcer is infected (table 1). Acute ulcers are defined as being present for less than 6 weeks and, if infected, it is likely that a narrow spectrum of microorganisms is involved.

As a result a narrow spectrum antibiotic is most appropriate initially and can be altered depending on microbiology culture and sensitivity results in a non-responding wound. If the duration of the ulcer is longer than 6 weeks it is defined as a chronic ulcer and a broad spectrum antibiotic would be recommended because the infection is more likely to be polymicrobial (table 1).    

In the case of chronic ulcers information on increased exudate levels, odour changes and increased pain may indicate potential infection.  In particular, a previously non-painful neuropathic foot ulcer can become painful due to infection. Patients may also report changes in glycaemic control or systemic symptoms such as fever, rigors or nausea and vomiting that are linked to more severe infections.

Table 1 : FDUK (Foot in Diabetes UK) recommended antibiotic choice