9.4 Necrotizing fasciitis
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Necrotizing Fasciitis | Surgical debridement and Piperacillin- tazobactam 4.5g every 6 hours + Clindamycin 600 mg to 900 mg q8h Duration is 48 to 72 hours after clinical improvement and fever resolution or until no surgical intervention is needed | Meropenem 1g IV every 8 hours + Clindamycin 600 mg to 900 mg q8h Use vancomycin 15 to 20 mg/kg/dose every 8 to 12 hours instead of Clindamycin. (if MRSA is suspected) If organism isolated is group A beta-hemolytic streptococci use: Inj crystalline penicillin 4 million units q4h + Inj Clindamycin 600-900 mg q8h Duration is 48 to 72 hours after clinical improvement and fever resolution or until no surgical intervention is needed. | These patients are extremely ill and should be transferred immediately to the intensive care unit. The treatment of necrotizing fasciitis is surgery, and no time should be wasted calling for a surgical consult. The earlier the surgery is undertaken, the better the outcome. Based on culture reports, prompt de- escalation should be done. Gram stain may be used for de- escalation. |
For common etiological agents of Necrotizing fasciitis, see Annexure B.9.4
Additional Information
- Empiric antibiotic treatment should be broad as the etiology of necrotizing fasciitis can be polymicrobial (mixed aerobic-anaerobic microbes) or monomicrobial (group A streptococci, community-acquired MRSA).
- Necrotizing fasciitis, also known as flesh-eating disease is a type of aggressive skin and soft tissue infection (SSTI) that spreads rapidly and can lead to death.
References
1. Guliyeva G, Huayllani MT, Sharma NT, Janis JE. Practical Review of Necrotizing Fasciitis: Principles and Evidence-based Management. Plast Reconstr Surg Glob Open. 2024 Jan 19;12(1):e5533. doi: 10.1097/GOX.0000000000005533. PMID: 38250213; PMCID: PMC10798703