# Development and Control of Biofilms in Diabetic Foot Infections: A Narrative Review
## 16 Strategies Used for Treatment of Biofilm in DFI
Aminoglycos-sides like gentamicin, which are sometimes used in severe infections, are associated with significant nephrotoxicity, particularly in patients with pre-existing renal impairment or prolonged therapy. The drug can lead to acute tubular necrosis, which may necessitate careful monitoring of renal function. Ototoxicity, a less common but serious side effect, can cause irreversible hearing loss and vestibular dysfunction, impacting the patient's quality of life. Linez solid, used for multidrug-resistant gram-positive organisms such as MRSA, has been reported to cause reversible myelosuppression, including anemia, thrombocytopenia, and leukopenia, particularly with prolonged use. Additionally, peripheral neuropathy and optic neuropathy, which can become irreversible, have been documented in patients undergoing long-term treatment. Monitoring of complete blood counts and neurological symptoms is critical during therapy [149; 182]. Vancomycin, a cornerstone in the treatment of MRSA infections, carries the risk of hypersensitivity reactions such as \"red man syndrome\", characterized by flushing, rash, and pruritus due to histamine release. While this reaction is generally manageable by slowing the infusion rate, severe cases may require treatment discontinuation [162]. Nephrotoxicity, particularly in combination with other nephrotoxic drugs, is another critical concern. The use of broad-spectrum antibiotics, particularly cephalosporins and fluoroquinolones, can disrupt normal gut flora, leading to Clostridioides difficile infection (CDI) [163]. This condition can complicate treatment, extend hospitalization, and significantly increase healthcare costs. A major risk associated with the use of antibiotics in biofilm-related infections is the development of antimicrobial resistance. Suboptimal dosing, prolonged treatment durations, and incomplete biofilm eradication can be selected for resistant bacterial strains. This resistance reduces the efficacy of current therapies and limits future treatment options [122; 123]. Fluoroquinolones, such as ciprofloxacin, may cause tendonitis or tendon rupture, particularly in older adults or those concurrently taking corticosteroids. Betalcatam antibiotics like piperacillin-tazolactam may result in hypersensitivity reactions, \begin{table}
\begin{tabular}{c c c c} \hline \hline
**Treatment** & & **Description** & **References** \\ \hline Carolacton & \(\bullet\) & Causes cell chain elongation and cell death of & \\  & & _S. mutans_ biofilm & [178] \\  & & Destroy biofilm cell membrane & \\ \hline Rhamolipid & Disrupts and eradicate _S. aureus_ biofilms & [178] \\ \hline  & \(\bullet\) & Increases stability of drugs & \\  & & Potential side effect: & \\ D-amino acids incorporation & \(\bullet\) & Schizophrenia—alters NMDA-dependent & [178; 179] \\  & & neurotransmission. & \\  & \(\bullet\) & Cataract & \\  & \(\bullet\) & Atherosclerosis & \\ \hline  & \(\bullet\) & Inhibit the formation of biofilm and eradicates & \\ Rhamolipid coated silver and iron & & preformed biofilm. & [178; 180] \\ oxide nanoparticles & & Diminishes cell adhesion, dispersing & \\  & & preformed biofilm & \\ \hline \hline \end{tabular}
\end{table} 
Table 4: _Cont._including anaphylaxis in patients with penicillin allergies. For emerging therapies like nanomaterials, phage therapy, and photodynamic therapy, we have highlighted the potential risks [134; 164]. For instance, the cytotoxicity of titanium oxide nanoparticles and the immune responses to bacterial endotoxins released during phage therapy are detailed. We have also noted localized skin sensitivity as a risk for photodynamic therapy [169].