OPTIMIZING ANTIBIOTIC STEWARDSHIP IN THE MANAGEMENT OF DIABETIC FOOT ULCER: A COMPREHENSIVE REVIEW

Diabetic foot infections (DFIs) are a major cause of morbidity, hospitalization and lower-limb amputation in individuals with diabetes. The complex interplay of neuropathy, ischemia, impaired immunity and polymicrobial colonization contributes to poor outcomes, while rising antimicrobial resistance further complicates management. Despite Staphylococcus aureus, including MRSA, being recognized as a common pathogen many regions especially in tropical countries show a predominance of Gram-negative organisms such as Klebsiella pneumoniae, E. coli and Pseudomonas aeruginosa. These findings highlight an urgent need for Antimicrobial Stewardship (AMS), which emphasizes culture-guided, severity-based antibiotic selection, shorter treatment durations and multidisciplinary care. Non-antibiotic interventions including debridement, off-loading, vascular optimization, and glycemic control are equally critical for healing.