Diabetic foot infection (DFI) remains a major cause of lower limb amputation in people with diabetes and typically requires prolonged systemic antibiotic therapy with surgical management when necessary. A systematic review and meta-analysis of 21 studies including 2188 participants, published in the Journal of Diabetes, compared the effectiveness of systemic antibiotics, local antibiotics, and combined therapy for the treatment of DFI.

The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance and searched eight sources. The analysis included 21 studies involving 2188 participants, comprising 12 randomized controlled trials and 9 observational studies. The study defined clinical cure as the primary outcome. Secondary outcomes included clinical improvement, time to clinical cure, recurrence, amputation rates, and pathogen eradication.

The pooled analysis showed that combined local and systemic antibiotic therapy achieved higher clinical cure rates than systemic antibiotics alone (odds ratio [OR] 2.08; 95% CI 1.30-3.35; p<0.05). The analysis also showed a shorter time to clinical cure with combination therapy, with a mean reduction of 9.8 days (95% CI −15.1 to −4.4; p < 0.05). However, when the analysis included randomized controlled trials only, these differences did not remain statistically significant. Local antibiotic therapy used alone did not produce significant differences across the evaluated outcomes.

The findings indicate that evidence supporting local antibiotic therapy in DFI remains uncertain because of heterogeneity and potential bias across the included studies. Further high-quality randomized controlled trials are required to clarify the role of local antimicrobial therapy in DFI management.