Necrotizing Fasciitis
Monomicrobial: S. pyogenes, MSSA/MRSA, Clostridial spp; In setting of traumatic injury in sea water or fresh water: Vibrio vulnificans, Aeromonas hydrophila
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Polymicrobial: Any of the above organisms + Gram-negative bacilli, Bacterioides, and other anaerobes
Vancomycin [see dosing recs in Bugs and Drugs]
AND
Cefepime 150mg/kg/day IV div q8h (max 2000mg/dose)
AND
Clindamycin 40mg/kg/day IV div q8h (max 900 mg/dose)¹
Empiric Therapy & Alternative Regimens
Duration of Therapy & Clinical Pearls
Consult Infectious Diseases and General Surgery.
Red Flags: Pain disproportionate to exam findings, tenderness spreading beyond cutaneous findings, wooden-hard induration, development of anesthesia, crepitus, bullous lesions, skin necrosis, ecchymosis, systemic toxicity.
Aggressive, emergent wound debridement is a critical component of therapy. Imaging may assist w/diagnosis but should not delay surgical therapy if there is a high index of suspicion.
Blood and tissue cultures are extremely important to provide etiological organism to assist in determination of definitive treatment regimen.
Clindamycin is included here during the empiric phase of therapy to inhibit toxin synthesis and is typically continued for the first 48 hours of therapy.