When applying silver sulfadiazine, place only a thin layer over the wound surface after the wound has been debrided and cleaned. Dressings should be changed every 24 hours. Early detection of infected diabetic foot ulcers may be difficult because neuropathy and cellular abnormalities secondary to diabetes can mask symptoms of pain, erythema, and increased skin temperature. Prolonged hyperglycemia may be the first indication of infection. Foot infections in diabetic patients are commonly polymicrobial and may involve aerobes and anaerobes.
Treatment consists of local wound care and the use of systemic antibiotics.
Nonviable tissue must be debrided from the ulcer site. Progressive cellulitis unresponsive to oral therapy, systemic signs of infection, abscess formation, and osteomyelitis may require hospitalization and the use of IV antibiotics. Reinforce patient teaching. Additional considerations are required for a full-thickness ulcer that does involve exposure of tendon, capsule, muscle, or bone. This is especially important before a TCC or dressing is used.