Management and outcome of severe diabetic foot infections.

We evaluated the bacteriological and clinical efficacy of the combination of ciprofloxacin/clindamycin in severe diabetic foot infections and we tried to elucidate the relationship between the vascular status of the lower limbs and the outcome of these infections. Initial empirical antibiotic therapy with ciprofloxacin (300 mg/12 hrs IV) and clindamycin (600 mg/8 hrs IV) was administered in 84 hospitalized diabetics with severe lower limb infections. This treatment was continued only in cases with primary clinical improvement. The major endpoints of treatment were: cure, improvement and failure. Evaluation of the vascular status of the lower extremities was performed by high resolution imaging coloured ultrasonography, US-Doppler and TcPO2 measurements. Polymicrobial flora was found in 83% of the cases with an average 2.8 species per specimen. Osteomyelitis was detected in 58 % of the patients. After five days of IV administration of ciprofloxacin and clindamycin the response rate was 95.2%. After three weeks of therapy the clinical outcome was: cure 54.8%, improvement 23.8%, and failure 21.4%. The long term follow up (mean duration 16 months) revealed complete healing of the skin lesions in 63 patients (75%). Unfavorable prognostic factors for these infections were: ankle systolic blood pressure <50 mmHg or toe systolic blood pressure < 30 mmHg and TcPO2 < 20 mmHg. The side effects of the combination of ciprofloxacin/clindamycin were mild and there were no cases of pseudomembranous enterocolitis. The combination of ciprofloxacin/clindamycin was found to provide an excellent empirical as well as definitive treatment of severe diabetic foot infections. The evaluation of the vascular status and the severity of ischaemia of the lower limbs has a strong predictive value in the outcome of these infections.

Honey may have a laxative effect on normal subjects because of incomplete fructose absorption.

Honey contains fructose in excess of glucose, which may lead to incomplete fructose absorption associated with abdominal symptoms and/or diarrhea. This hypothesis was investigated in 20 healthy volunteers (13 males, 7 females) with a mean (+/- SD) age of 35.9 +/- 12.1 y. Each subject drank the following aqueous solutions in random order: 20 g lactulose, 100 g honey, 50 g honey, and 35 g each of a glucose and fructose mixture. The breath-hydrogen concentration was measured every 15 min for 6 h. Semiquantitative estimates of carbohydrate malabsorption were assessed with lactose as a nonabsorbable standard. Breath-hydrogen concentrations increased by 52 +/- 6, 30 +/- 4, 20 +/- 3, and 4 +/- 1 ppm (mean +/- SEM) after each of the four test solutions, respectively. The estimated carbohydrate malabsorption was 10.3 +/- 1.8, 5.9 +/- 1.2, and 0.5 +/- 0.2 g after 100 g honey, 50 g honey, and the glucose-fructose mixture, respectively (F[2,57] = 16.05, P < 0.001). Within 10 h after the ingestion of 100 g honey, 50 g honey, and the glucose-fructose mixture, six, three and none of the volunteers, respectively, reported loose stools (chi 2 = 7.1, df = 2, P < 0.03). The results of this study suggest that carbohydrate malabsorption after ordinary doses of honey is frequent in healthy adults and may be associated with abdominal complaints. Honey may have a laxative effect in certain otherwise healthy individuals, probably because of incomplete fructose absorption.