A systematic review and meta-analysis of randomized controlled trials of systemic antibiotics for diabetes-related foot infections.

Objective: Diabetes-related foot infections (DFIs) are prevalent in patients with diabetes mellitus, often leading to severe complications, including amputations. This study aims to assess the efficacy and safety of systemic antibiotics in DFI treatment.

Research design and methods: A systematic review was conducted by searching PubMed, Cochrane databases, and Embase for randomized controlled trials up to August 4, 2024, evaluating the clinical efficacy of systemic antibiotics for DFIs. Primary outcomes were clinical efficacy and safety, comparing different antibiotic classes to penicillins. Subgroup analysis was based on DFI severity.

Results: Of 24 studies, 16 were included in the meta-analysis. Linezolid showed a potential efficacy advantage over penicillins for DFIs but had more adverse effects. Clinical efficacy and safety were comparable across carbapenems and quinolones versus penicillins. Ertapenem showed no significant difference from piperacillin/tazobactam in treating moderate or severe DFIs.

Conclusion: In conclusion, while linezolid may offer a potential efficacy advantage over penicillins in treating DFIs, it is associated with a higher risk of drug-related adverse effects. Penicillins demonstrate comparable clinical efficacy and safety to carbapenems and fluoroquinolones for DFI management. For moderate to severe DFIs, piperacillin/tazobactam and ertapenem are viable options, though treatment should be guided by local antimicrobial resistance patterns.