TY - JOUR
T1 - Inappropriate antibiotic administration in the setting of Charcot arthropathy
T2 - A case series and literature review
AU - Shazadeh Safavi, Kiya
AU - Janney, Cory
AU - Shazadeh Safavi, Pejma
AU - Kunzler, Daniel
AU - Jupiter, Daniel
AU - Panchbhavi, Vinod
N1 - Publisher Copyright:
© 2021 Primary Care Diabetes Europe
PY - 2022/2
Y1 - 2022/2
N2 - Aims: Differentiating Charcot neuropathic osteoarthropathy (CN) from infection is challenging. The diagnosis of CN is often missed or delayed, resulting in inappropriate and delayed treatment. We hypothesized that the misdiagnosis of CN results in inappropriate antibiotic prescriptions and explore the sequelae of unnecessary antibiotic use. Methods: A retrospective review of patient electronic medical records from January 2010 to December 2017 was conducted for those diagnosed with CN after being referred to an orthopaedic foot and ankle specialist. Results: Our review showed 58 of 103 (56%) patients received antibiotics on the date, or within the next 7 days, of referral to foot and ankle orthopaedic specialist. The antibiotic of choice given on referral were as follows: Sulfamethoxazole/Trimethoprim 18 of 58 (31%), doxycycline 13 of 58 (22%), clindamycin 13 of 58 (22%), cephalexin 9 of 58 (16%), minocycline 5 of 58 (9%). Conclusion: Missed diagnoses for CN are common and result in complications stemming from inappropriate treatment, delays in appropriate therapy, and may accelerate antibiotic resistance. Misdiagnosis of CN contributes to the inappropriate use of prescription antibiotics.
AB - Aims: Differentiating Charcot neuropathic osteoarthropathy (CN) from infection is challenging. The diagnosis of CN is often missed or delayed, resulting in inappropriate and delayed treatment. We hypothesized that the misdiagnosis of CN results in inappropriate antibiotic prescriptions and explore the sequelae of unnecessary antibiotic use. Methods: A retrospective review of patient electronic medical records from January 2010 to December 2017 was conducted for those diagnosed with CN after being referred to an orthopaedic foot and ankle specialist. Results: Our review showed 58 of 103 (56%) patients received antibiotics on the date, or within the next 7 days, of referral to foot and ankle orthopaedic specialist. The antibiotic of choice given on referral were as follows: Sulfamethoxazole/Trimethoprim 18 of 58 (31%), doxycycline 13 of 58 (22%), clindamycin 13 of 58 (22%), cephalexin 9 of 58 (16%), minocycline 5 of 58 (9%). Conclusion: Missed diagnoses for CN are common and result in complications stemming from inappropriate treatment, delays in appropriate therapy, and may accelerate antibiotic resistance. Misdiagnosis of CN contributes to the inappropriate use of prescription antibiotics.
KW - Charcot foot
KW - Charcot neuropathic osteoarthropathy
KW - Delayed treatment
KW - Diabetes
KW - Diabetes mellitus
KW - Inappropriate treatment
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U2 - 10.1016/j.pcd.2021.11.009
DO - 10.1016/j.pcd.2021.11.009
M3 - Article
C2 - 34893452
AN - SCOPUS:85121723969
SN - 1751-9918
VL - 16
SP - 202
EP - 206
JO - Primary Care Diabetes
JF - Primary Care Diabetes
IS - 1
ER -