Diabetic foot ulcer (DFU) is one of the most debilitating complications of diabetes mellitus, contributing significantly to morbidity, limb amputations, and economic burden worldwide. Defined by the World Health Organization and the International Working Group on the Diabetic Foot as ulceration, infection, or destruction of foot tissues associated with neuropathy and peripheral vascular disease, DFU represents a global health challenge with regional variations in prevalence and management. This descriptive cross-sectional study, conducted over ten months at a tertiary care hospital in Peshawar, Pakistan, aimed to evaluate pharmacotherapy patterns and microbial profiles in DFU patients. A total of 200 patients were studied, with the highest concentration from Peshawar (n=80), followed by Charsadda, Hangu, Kohat, and Parachinar. Most patients were aged 50–60 years, and pain was the predominant complaint (n=120). Culture sensitivity testing revealed a polymicrobial infection landscape, with 44 cases showing no growth, while the most frequently isolated organisms were Enterobacter with Pseudomonas aeruginosa (n=32), E. coli (n=28), Proteus mirabilis (n=20), and Providencia species (n=20). These pathogens are often associated with multidrug resistance and complicate wound healing due to biofilm formation and immune evasion. Findings highlight the urgent need for early detection, culture-guided antibiotic therapy, and multidisciplinary foot care approaches to prevent complications like chronic infections and amputations. Moreover, the high prevalence of resistant strains stresses the importance of antibiotic stewardship and region-specific treatment protocols. The study underscores the need for patient education, improved wound care practices, and decentralized access to diabetic foot services, especially in high-burden areas like Peshawar. With DFUs continuing to impose a silent yet severe impact on diabetic populations, focused interventions at both community and clinical levels are essential to curb this preventable complication.

Keywords: Diabetic Foot Ulcer (DFU), Microbial Profile, Culture Sensitivity