Pharmacoeconomic Burden of Antibiotic usage in Diabetic Foot Ulcer (DFU) Management among Diabetics

Abstract

Diabetic foot ulcer (DFU) has been reported as a severe medical complication that occurs due to poor management of diabetes mellitus (DM). About 3%-8% of DM patients suffer from DFU infection once in their lifetime. A wide range of antibiotics are used for longer time periods for the management of DFU infection depending upon type and severity of the infection. As DFUs impose pharmacoeconomic burden on the healthcare systems across the entire globe, the economic importance of antibiotics usage in the treatment of DFUs among DM patients can’t be ignored. This systematic review was conducted by following “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines to evaluate the pharmacoeconomic burden of antibiotic usage in the management of DFUs among DM patients. Five databases were used for data search, collection, and extraction including PubMed, MEDLINE, EMBSE, Cochrane Library, and PsycInfo, on 13 October 2025. To search data, we used MeSH keywords of “diabetic foot ulcer”, “diabetic foot”, “pharmacoeconomic burden”, “economic cost”, “costs of antibiotics in diabetic foot”, “antibiotic usage in foot infections in diabetes”, “antibiotic resistance in DFUs management” and “outcomes of antibiotics usage in foot infections of diabetics” among all databases. A total of 12 out of total searched papers met the study criteria and were included in the study.  Among 12 selected studies, 13930 DM patients with DFU were analyzed in a recent study. Quality assessment of the included studies was done by using a 24-item Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. It was observed that pharmacoeconomic burden of antibiotics usage among DFU patients has been tremendously increased in recent years due to high prevalence of DM, delayed healing process, multiple antibiotics usage, antibiotics resistance and complicated comorbidities among DM patients. Though parenteral antibiotic therapy has replaced traditional drug therapy and somehow has reduced the DFU infection-linked antibiotic usage cost. However, there is a great need to manage the high prevalence of DM in order to reduce DFU infection rate which directly imposes an economic burden on the diabetes care budget of healthcare systems of developed as well as developing countries.