Comparative Clinical Efficacy of Ceftriaxone Sodium and Cefoperazone–Sulbactam in the Management of Diabetic Foot Infections: A Prospective Cohort Study

Abstract

Background: Diabetic foot infections (DFIs) represent a major complication of diabetes mellitus, contributing substantially to hospitalization rates, amputation risk, and healthcare costs, particularly in resource-limited settings where broad-spectrum intravenous antibiotics are prescribed empirically without microbiological confirmation. Objective: To compare the clinical wound-healing efficacy and non-response rates of intravenous ceftriaxone sodium versus intravenous cefoperazone–sulbactam in adult patients with diabetic foot infections in Peshawar, Khyber Pakhtunkhwa, Pakistan, and to characterize the spectrum of presenting foot complications in this cohort. Methods: A prospective comparative cohort study was conducted at the SS Diabetic and Medical Care Center, Peshawar. Eighty patients aged ≥30 years with established diabetes mellitus and active diabetic foot infections were enrolled and allocated to receive either intravenous ceftriaxone sodium 2 g twice daily (Group 1; n = 40) or intravenous cefoperazone–sulbactam 2 g twice daily (Group 2; n = 40) for seven consecutive days. Wound healing was assessed at day 7 using a validated six-point ordinal scale (0%–100%). The primary outcome, clinical response rate, was compared between groups using Fisher's exact test, with 95% confidence intervals calculated by the Wilson score method. Results: Clinical response rates were 85.4% (95% CI: 71.3%–93.2%) for ceftriaxone sodium and 89.4% (95% CI: 76.2%–95.7%) for cefoperazone–sulbactam; the 4.0 percentage-point difference was not statistically significant (p = 0.499; OR for non-response 1.53, 95% CI: 0.42–5.54). Diabetic foot ulcer was the most prevalent complication (53%), followed by cellulitis (31%) and skin gangrene (15%). Conclusion: Both regimens demonstrated clinically acceptable wound-healing efficacy as cost-effective empiric options for diabetic foot infections in resource-limited settings, though future adequately powered, randomised trials incorporating microbiological confirmation are required to establish definitive comparative evidence.