Necrotizing fasciitis medical therapy

Necrotizing fasciitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Necrotizing fasciitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
CT
MRI
Ultrasound
Biopsy
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Future or Investigational Therapies
Case Studies
Case #1
Necrotizing fasciitis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Necrotizing fasciitis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Necrotizing fasciitis medical therapy
CDC on Necrotizing fasciitis medical therapy
Necrotizing fasciitis medical therapy in the news
Blogs on Necrotizing fasciitis medical therapy
Directions to Hospitals Treating Necrotizing fasciitis
Risk calculators and risk factors for Necrotizing fasciitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Treatment

The diagnosis is confirmed by either blood cultures or aspiration of pus from tissue, but early medical treatment is crucial and often presumptive; thus, antibiotics should be started as soon as this condition is suspected. Initial treatment often includes a combination of intravenous antibiotics including penicillin, vancomycin and clindamycin. If necrotizing fasciitis is suspected, surgical exploration is always necessary, often resulting in aggressive debridement (removal of infected tissue). As in other maladies characterized by massive wounds or tissue destruction, hyperbaric oxygen treatment can be a valuable adjunctive therapy, but is not widely available. Amputation of the affected organ(s) may be necessary. Repeat explorations usually need to be done to remove additional necrotic tissue. Typically, this leaves a large open wound which often requires skin grafting. The associated systemic inflammatory response is usually profound, and most patients will require monitoring in an intensive care unit.

Antimicrobial regimen

• Necrotizing fasciitis

• 1. Mixed infections

• 1.1 Adults

• Preferred regimen (1): Piperacillin-tazobactam 3.37 g IV q6–8h AND Vancomycin 30 mg/kg/day IV q12h
• Note: In case of severe pencillin allergy, use clindamycin or metronidazole with an aminoglycoside or fluoroquinolone
• Preferred regimen (2): Imipenem-cilastatin 1 g IV q6–8h
• Preferred regimen (3): Meropenem 1 g IV q8h
• Preferred regimen (4): Ertapenem 1 g IV q24h
• Preferred regimen (5): Cefotaxime 2 g IV q6h AND Metronidazole 500 mg IV q6h
• Preferred regimen (6): Cefotaxime 2 g IV q6h AND Clindamycin 600–900 mg IV q8h

• 1.2 Pediatrics

• Preferred regimen (1): Piperacillin-tazobactam 60–75 mg/kg/dose of the Piperacillin component IV q6h AND Vancomycin 10–13 mg/kg/dose IV q8h
• Note: Severe pencillin allergy, use clindamycin or metronidazole with an aminoglycoside or fluoroquinolone)
• Preferred regimen (2): Meropenem 20 mg/kg/dose IV q8h
• Preferred regimen (3): Ertapenem 15 mg/kg/dose IV q12h for children 3 months-12 years
• Preferred regimen (4): Cefotaxime 50 mg/kg/dose IV q6h AND Metronidazole 7.5 mg/kg/dose IV q6h
• Preferred regimen (5): Cefotaxime 50 mg/kg/dose IV q6h AND Clindamycin 10–13 mg/kg/dose IV q8h

• 2. Streptococcus infection

• 2.1 Adults

• Preferred regimen: Penicillin 2–4 MU IV q4–6h AND Clindamycin 600–900 mg IV q8h
• Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin

• 2.2 Pediatric

• Preferred regimen: Penicillin 0.06–0.1 MU/kg/dose IV q6h AND Clindamycin 10–13 mg/kg/dose IV q8h
• Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin

• 3. Staphylococcus aureus

• 3.1 Adults

• Preferred regimen (1): Nafcillin 1–2 g IV q4h
• Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
• Preferred regimen (2): Oxacillin 1–2 g IV q4h
• Preferred regimen (3): Cefazolin 1 g IV q8h
• Preferred regimen (4): Vancomycin 30 mg/kg/day IV q12h
• Preferred regimen (5): Clindamycin 600–900 mg IV q8h

• Pediatrics

• Preferred regimen (1): Nafcillin 50 mg/kg/dose IV q6h
• Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
• Preferred regimen (2): Oxacillin 50 mg/kg/dose IV q6h
• Preferred regimen (3): Cefazolin 33 mg/kg/dose IV q8h
• Preferred regimen (4): Vancomycin 15 mg/kg/dose IV q6h
• Preferred regimen (5): Clindamycin 10–13 mg/kg/dose IV q8h (bacteriostatic; potential cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)

• 4. Clostridium species

• 4.1 Adults

• Preferred regimen: Clindamycin 600–900 mg IV q8h AND Penicillin 2–4 MU IV q4–6h

• 4.2 Pediatrics

• Preferred regimen: Clindamycin 10–13 mg/kg/dose IV q8h AND Penicillin 0.06-0.1 MU/kg/dose IV q6h

• 5. Aeromonas hydrophila

• 5.1 Adults

• Preferred regimen (1): Doxycycline 100 mg IV q12h AND ciprofloxacin 500 mg IV q12h

• Preferred regimen (2): Doxycycline 100 mg IV q12h AND ceftriaxone 1 to 2 g IV q24h

• 5.2 Pediatrics

• Not recommended for children but may need to use in life-threatening situations

• 6. Vibrio vulnificus

• 6.1 Adults

• Preferred regimen (1): Doxycycline 100 mg IV q12h AND ceftriaxone 1 g IV qid
• Preferred regimen (2): Doxycycline 100 mg IV q12h AND cefotaxime 2 g IV tid

• 6.2 Pediatrics

• Not recommended for children but may need to use in life-threatening situation