From the Guidelines
Necrotizing fasciitis in pediatric patients is a medical emergency that requires immediate attention, and the recommended treatment involves a combination of surgical and medical interventions to minimize morbidity, mortality, and improve quality of life.
Initial Management
Initially, broad-spectrum antibiotics such as Clindamycin (10-13 mg/kg/dose IV every 6-8 hours) and Vancomycin (10-15 mg/kg/dose IV every 6 hours) should be administered to cover a wide range of potential pathogens, as suggested by 1.
Surgical Intervention
Surgical debridement of the affected area is crucial and should be performed as soon as possible to remove necrotic tissue and prevent further spread of the infection, as emphasized by 1.
Supportive Care
Supportive care, including fluid resuscitation, pain management, and monitoring for potential complications, is also essential to ensure optimal outcomes.
Adjunctive Therapies
In some cases, adjunctive therapies such as hyperbaric oxygen therapy or intravenous immunoglobulin (IVIG) may be considered, but their use should be individualized and guided by the clinical response, with IVIG potentially beneficial in cases caused by group A streptococci, as noted in 1.
Antibiotic Therapy Duration
The duration of antibiotic therapy typically ranges from 7-14 days, but may be extended based on the clinical course and response to treatment.
Multidisciplinary Collaboration
Close monitoring and collaboration with a multidisciplinary team, including pediatricians, surgeons, and infectious disease specialists, is crucial to ensure optimal management and outcomes.
From the FDA Drug Label
Pediatric Patients 1 month of age to 16 years: Parenteral (IM or IV) Administration: 20 to 40 mg/kg/day in 3 or 4 equal doses. The higher doses would be used for more severe infections. The treatment for necrotizing fasciitis in pediatric patients is Clindamycin 20 to 40 mg/kg/day in 3 or 4 equal doses, with the higher doses used for more severe infections 2.
- The dosage is based on total body weight, regardless of obesity.
- Alternatively, pediatric patients may be dosed on the basis of square meters body surface: 350 mg/m2/day for serious infections and 450 mg/m2/day for more severe infections.
- For pediatric patients less than 1 month, the recommended dosage is 15 to 20 mg/kg/day in 3 to 4 equal doses 2.
From the Research
Treatment Overview
The treatment for necrotizing fasciitis in pediatric patients typically involves a combination of surgical debridement, antibiotic therapy, and supportive care.
- Surgical debridement is a crucial step in the management of necrotizing fasciitis, as it helps to remove the infected tissue and prevent the spread of the infection 3, 4, 5, 6.
- Antibiotic therapy is also essential, as it helps to control the infection and prevent its spread to other parts of the body 4, 5, 7, 6.
- Supportive care, such as fluid resuscitation, pain management, and wound care, is also important in the management of necrotizing fasciitis 3, 4, 5, 6.
Surgical Debridement
Surgical debridement is a critical component of the treatment of necrotizing fasciitis in pediatric patients.
- The goal of surgical debridement is to remove all infected tissue, including skin, subcutaneous tissue, and fascia 3, 4, 5, 6.
- Serial surgical debridement may be necessary to ensure that all infected tissue is removed 3, 4, 5.
- The use of negative pressure wound therapy (NPWT) and vacuum-assisted closure (VAC) can help to promote wound healing and closure after surgical debridement 3.
Antibiotic Therapy
Antibiotic therapy is an essential component of the treatment of necrotizing fasciitis in pediatric patients.
- The choice of antibiotics will depend on the suspected or confirmed causative organisms, as well as the severity of the infection 4, 5, 7, 6.
- Broad-spectrum antibiotics, such as penicillin, an aminoglycoside, and metronidazole, may be used initially, with adjustments made based on culture and sensitivity results 5, 6.
Supportive Care
Supportive care is also important in the management of necrotizing fasciitis in pediatric patients.