Brief Answer: Please, send specimen for culture and sensitivity Detailed Answer: Hi and thank you do much for this query. I am so sorry to hear about this infection that has been going on this long. From all the information you have provided, I am concerned that the antibiotics already tried are not effective on the germ(s) causing this infection. It would be a great idea to send a sample of nail, pus, tissue from this infected toe for culture and sensitivity testing. This would identify the germ causing this problem and also what antibiotic(s) is best indicated for the treatment. This is even more important seen the fact that you have been on multiple antibiotics before. This increases the chances for resistant strains to colonize and invade body tissues. Also, this infection may be caused by multiple germs that are not sensitive to a single antibiotic or a combination of a bacterial and fungal infection that is commonly seen on cases of super infected onychymycoses that require the combination of an antibacterial and an antifungal agent to control the infection. Your diabetic status calls for aggressive measures to treat this infection because of the potential complications. Getting a culture and sensitivity testing would help orient efforts. If we are certain that the antibiotics being used is effective and the infection still persists, this would prompt local contributing factors to be like poor blood supply investigated. In all, get a specimen to the laboratory for culture to identify the germ(s) and what antibiotics are required to sterilize this infected nail. Antibiotics would be adapted based on these findings. Continuing antibiotics blindly would not be the best of ideas at this time, Zyvox is not an everyday antibiotic and has a very small spectrum and should not be used without adequate backings. I hope this helps. I wish you well. Feel free to ask for more information and clarification if need be. Thanks for using our services. Dr. Ditah, MD.

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Brief Answer: See below Detailed Answer: I a happy to learn that the culture results were used in making the decision to get you on this medication. I understand your worry about lactic acidosis. Though a possible side effect, it is very rare. All drugs have side effects and I think we have to see what the potential benefits and risks are each time we are making the decision to use a drug or not. The benefits here outweigh the risk and possible chances of having lactic acidosis. If you were to go by this stringent standards, you would never take any medications because of the potential side effects. Septra can cause severe burns in patients, yet you took it without any problems. This holds true for most medications. Our knowledge of side effects is not to stop us from taking the medications but to increase our alertness so that we can pick up warning signs earlier and intervene to prevent any potential complication in time. With this knowledge, be on the watch and report immediate symptoms to your physician while on this medication for prompt investigation and intervention. I hope this helps. Feel free to ask for more clarification if needed. Thanks. Dr. Ditah, MD.

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