10.3 Gas gangrene
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Traumatic gas gangrene: lethal infection of soft tissue and is synonymous with myonecrosis usually arise in traumatized tissue. | Penicillin G 4million Units per day 4 hrly + Clindamycin 900mg 8 hr + Aggressive surgical debridement | Clindamycin 900 mg IV q8h may be used alone in case of past history of anaphylaxis to penicillin | Immediately start treatment with antibiotics, early surgical consultation with extensive debridement, intravenous fluid resuscitation, ICU monitoring, and samples should be collected for anaerobic culture. |
| Spontaneous Gas gangrene | In spontaneous gas gangrene; Inj Piperacillin- tazobactam 4.5g q6h + Inj Clindamycin 900mg q8h Duration of therapy: 10 to 21 days till wound is stabilized and clear of infection. | Duration of therapy: 10 to 21 days till wound is stabilized and clear of infection | Fasciotomy may be necessary to relieve compartment pressures. It is important to have coordinated care for these critically ill patients with an intensivist, general surgeon, orthopaedic surgeon, urologist (in the setting of Fournier’s gangrene of the testicles and perineal structures), gynaecologist (in the setting of uterine gas gangrene), infectious disease specialist, gastroenterologist (in the setting of spontaneous gas gangrene). |
For common etiological agents of Gas gangrene, see Annexure B.10.3
References
1. Carter GP, Cheung JK, Larcombe S, Lyras D. Regulation of toxin production in the pathogenic clostridia. Mol Microbiol. 2014 Jan;91(2):221-31. doi: 10.1111/mmi.12469. PMID: 24563915.
2. Altemeier WA, Fullen WD. Prevention and Treatment of Gas Gangrene. JAMA. 1971;217(6):806–813. doi:10.1001/jama.1971.03190060046011