A 65 year old woman was admitted to the Surgical ward in a rural hospital. From her history, she was at a clinic for over 6 months before coming to this hospital. She came with a septic ulcer on the dorsal surface of her left foot, which is about 10cm X 6cm in size with dead tissues. She complained bitterly of poor management in the previous clinic though she has forgotten all the medications she took, and there was no note that accompanied her. On arrival in this rural hospital she was screened for Diabetes Mellitus and it can out negative. A wound swab was done for culture and Sensitivity, and the result came out to be; pseudomonas aeruginosa isolated after 24hrs incubation at 37 degree Celsius. Resistant to ofloxacin, augmentin, Genticin, Ca3, Ciprofloxacin and Ampilcilin. Only sensitive to amikacin (3+) .. Since the result came out. She has been on Iv Amikacin 500mg bid, Vitamin C and daily dressings with Eusol/Honey for the past 14 days. During the ward round last week, the physician noticed there is no significant improvement. The ulcer is still oozing out fluid a little time to time. What could be the better approach for this case? Thank you.
