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The healthcare systems are often not equipped to conduct the culture and the sensitivity tests required for prescribing a targeted antibiotic treatment for diabetic foot infection (DFI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluate antibiotic stewardship programmes for DFIs, at every level of health care, with an emphasis on resource\u2010poor settings such as in Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The management of DFI very often is adapted to the financial and practical realities of the resource\u2010poor regions. The application of the point\u2010of\u2010care Gram stain of deep tissue samples is efficient, rapid, low cost and ubiquitously available. Upon the identification of the predominant pathogen in the Gram stain, a semi\u2010quantitative preemptive antibiotic treatment can be started in accordance with the World Health Organization Aware, Watch and Restrict Essential Medicine List. This list is catered to every country and is a powerful tool. However, some basic knowledge of the local microbiological epidemiology is necessary to choose the most appropriate agent. We report our experience on using the rapidly available Gram stain for narrowing the preemptive choice of listed antibiotic agents, as an economic tool for antibiotic stewardship in DFIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the practical and resource\u2010saving management of DFI, the \u2018therapeutic\u2019 use of Gram stains is not common in resource\u2010rich countries but should be added to the arsenal of the general efforts for antibiotic stewardship.<\/jats:p><\/jats:sec>","DOI":"10.1002\/edm2.503","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T04:39:22Z","timestamp":1719376762000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Antibiotic Stewardship in the Management of Infected Diabetic Foot Ulcer Disease in Less Developed Countries"],"prefix":"10.1002","volume":"7","author":[{"given":"Zulfiqarali\u00a0G.","family":"Abbas","sequence":"first","affiliation":[{"name":"Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"},{"name":"Abbas Medical Center  Dar es Salaam Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raidah\u00a0R.","family":"Gangji","sequence":"additional","affiliation":[{"name":"Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"},{"name":"Hubert Kairuki Memorial University  Dar es Salaam Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5552-0973","authenticated-orcid":false,"given":"Ilker","family":"U\u00e7kay","sequence":"additional","affiliation":[{"name":"Infectiology Balgrist University Hospital  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,6,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109155"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2147\/CWCMR.S98762"},{"key":"e_1_2_10_5_1","unstructured":"International Working group on the Diabetic Foot (IWGDF) The Development of Global Consensus Guidelines on the Management and Prevention of the Diabetic Foot 2019. 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