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NICE updates foot care guidance to prevent harm from foot infections

New, updated guidance on foot care has been published by The National Institute for Health and Care Excellence (NICE).

NICE guideline, NG19, on ‘Diabetic foot problems: prevention and management’ has been updated to include new recommendations on the prescribing of antibiotics for diabetic foot infections.

While the guidelines are developed to set standards of healthcare for clinicians, the guidelines can also be useful for people with diabetes to know what level of care they can expect.

The new guidelines include a three-page summary of the guidance on antimicrobial treatment. Appropriate use of antibiotics is a keenly discussed topic in healthcare as overuse, or inappropriate use, of antibiotics can increase the risk of bacteria developing resistance to antibiotics.

One of the recommendations within the updated guidance is that antibiotics should continue to be prescribed immediately if there are symptoms of foot infection. This preserves the guidance laid out in 2015, when the original guideline was published.

The guidelines also state that while antibiotics should be used for treatment of foot infection, they should not be used the prevention of infection.

A committee was convened to examine the guidance. NICE explained the reasoning to continue immediate prescribing of antibiotics, stating: “The committee agreed that in people with diabetes, all foot wounds are likely to be colonised with bacteria. However, for people with a diabetic foot infection, prompt treatment of the infection is important to prevent complications, including limb-threatening infections.

“The committee agreed to retain the recommendation from the 2015 guideline that antibiotics should be started as soon as possible if a diabetic foot infection is suspected. The choice of antibiotic would depend on the severity of infection, although the committee acknowledged that the studies they looked at did not always differentiate between severities.”

Foot related complications are more common in people with diabetes and the new guideline will help clinicians to better prevent serious outcomes developing in people with diabetes presenting with foot problems.

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